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Issue Brief of the Commonwealth Fund

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https://www.readbyqxmd.com/read/29072894/medicaid-payment-and-delivery-system-reform-early-insights-from-10-medicaid-expansion-states
#1
Sara Rosenbaum, Sara Schmucker, Sara Rothenberg, Rachel Gunsalus, J Zoe Beckerman
Issue: Expanded Medicaid enrollment under the Affordable Care Act has heightened the importance of states’ roles as principal purchasers of health care for low-income and medically vulnerable populations. Concurrently, the federal government has augmented states’ purchasing tools. Goal: To examine the evolution of payment and delivery system reform in 10 ACA Medicaid expansion states. Methods: Analysis of state managed care policies, including a detailed review of purchasing documents as well as interviews with senior agency officials in 10 states...
October 1, 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/29068183/assessing-changes-to-medicaid-managed-care-regulations-facilitating-integration-of-physical-and-behavioral-health-care
#2
Elizabeth Edwards
Issue: As states consider how to effectively control Medicaid costs, many are looking to integrate behavioral and medical care, including long-term services and supports, particularly for individuals with complex needs. Goal: To summarize how recent federal regulations are encouraging an integrated approach to behavioral and physical health care. Findings and Conclusions: Two recent federal rules issued in 2016 are facilitating the transition to integrated care models: the Medicaid managed care rule and the Medicaid managed care mental health parity rule...
October 1, 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/29020733/how-have-health-insurers-performed-financially-under-the-aca-market-rules
#3
Michael J McCue, Mark A Hall
Issue: The Affordable Care Act (ACA) transformed the market for individual health insurance, so it is not surprising that insurers' transition was not entirely smooth. Insurers, with no previous experience under these market conditions, were uncertain how to price their products. As a result, they incurred significant losses. Based on this experience, some insurers have decided to leave the ACA’s subsidized market, although others appear to be thriving. Goals: Examine the financial performance of health insurers selling through the ACA's marketplace exchanges in 2015--the market’s most difficult year to date...
October 1, 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28990747/paying-for-prescription-drugs-around-the-world-why-is-the-u-s-an-outlier
#4
Dana O Sarnak, David Squires, Greg Kuzmak, Shawn Bishop
Issue: Compared with other high-income countries, the United States spends the most per capita on prescription drugs. Goal: To compare drug spending levels and trends in the U.S. and nine other high-income countries — Australia, Canada, France, Germany, the Netherlands, Norway, Sweden, Switzerland, and the United Kingdom; consider potential explanations for higher U.S. spending; and explore patients’ exposure to pharmaceutical costs. Method: Analysis of health data from the Organisation for Economic Co-operation and Development, the 2016 Commonwealth Fund International Health Policy Survey, and other sources...
October 1, 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28953345/outcomes-based-pharmaceutical-contracts-an-answer-to-high-u-s-drug-spending
#5
Elizabeth Seeley, Aaron S Kesselheim
Issue: Brand-name prescription drug prices are increasing in the United States, putting pressure on payers and patients. Some manufacturers have responded by offering outcomes-based contracts, in which rebate levels are tied to a specified outcome in the target population. Goal: To assess the expected benefits and limitations of outcomes-based pharmaceutical contracts in the U.S., including their potential impact on prescription drug spending. Methods: Semistructured interviews with payers, manufacturers, and policy experts...
September 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28929700/extending-the-children%C3%A2-s-health-insurance-program-high-stakes-for-families-and-states
#6
Sara Rosenbaum, Rachel Gunsalus, Sara Rothenberg, Sara Schmucker
Issue: Congress must decide whether to extend federal funding authority for the Children’s Health Insurance Program (CHIP), which ends September 30, 2017. CHIP operates much like Medicaid, providing federal matching payments for state program expenses, although CHIP’s funding rate is higher than the federal rate paid for traditional Medicaid and was further enhanced under the Affordable Care Act. States can use their CHIP funds to expand Medicaid, operate separate CHIP programs, or combine the two approaches...
September 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28880062/following-the-aca-repeal-and-replace-effort-where-does-the-u-s-stand-on-insurance-coverage-findings-from-the-commonwealth-fund-affordable-care-act-tracking-survey-march-june-2017
#7
Sara R Collins, Munira Z Gunja, Michelle M Doty
Issue: After Congress's failure to repeal and replace the Affordable Care Act, some policy leaders are calling for bipartisan approaches to address weaknesses in the law’s coverage expansions. To do this, policymakers will need data about trends in insurance coverage, reasons why people remain uninsured, and consumer perceptions of affordability. Goal: To examine U.S. trends in insurance coverage and the demographics of the remaining uninsured population, as well as affordability and satisfaction among adults with marketplace and Medicaid coverage...
September 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28836751/reducing-racial-and-ethnic-disparities-in-access-to-care-has-the-affordable-care-act-made-a-difference
#8
Susan L Hayes, Pamela Riley, David C Radley, Douglas McCarthy
ISSUE: Prior to the Affordable Care Act (ACA), blacks and Hispanics were more likely than whites to face barriers in access to health care. GOAL: Assess the effect of the ACA’s major coverage expansions on disparities in access to care among adults. METHODS: Analysis of nationally representative data from the American Community Survey and the Behavioral Risk Factor Surveillance System. FINDINGS AND CONCLUSIONS: Between 2013 and 2015, disparities with whites narrowed for blacks and Hispanics on three key access indicators: the percentage of uninsured working-age adults, the percentage who skipped care because of costs, and the percentage who lacked a usual care provider...
August 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28829534/how-medicaid-expansion-affected-out-of-pocket-health-care-spending-for-low-income-families
#9
Sherry Glied, Ougni Chakraborty, Therese Russo
ISSUE. Prior research shows that low-income residents of states that expanded Medicaid under the Affordable Care Act are less likely to experience financial barriers to health care access, but the impact on out-of-pocket spending has not yet been measured. GOAL. Assess how the Medicaid expansion affected out-of-pocket health care spending for low-income families compared to those in states that did not expand and consider whether effects differed in states that expanded under conventional Medicaid rules vs...
August 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28805362/how-the-affordable-care-act-has-helped-women-gain-insurance-and-improved-their-ability-to-get-health-care-findings-from-the-commonwealth-fund-biennial-health-insurance-survey-2016
#10
Munira Z Gunja, Sara R Collins, Michelle M Doty, Sophie Beautel
ISSUE: Prior to the Affordable Care Act (ACA), one-third of women who tried to buy a health plan on their own were either turned down, charged a higher premium because of their health, or had specific health problems excluded from their plans. Beginning in 2010, ACA consumer protections, particularly coverage for preventive care screenings with no cost-sharing and a ban on plan benefit limits, improved the quality of health insurance for women. In 2014, the law’s major insurance reforms helped millions of women who did not have employer insurance to gain coverage through the ACA’s marketplaces or through Medicaid...
August 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28745476/extending-marketplace-tax-credits-would-make-coverage-more-affordable-for-middle-income-adults
#11
Jodi Liu, Christine Eiber
ISSUE: Affordability of health coverage is a growing challenge for Americans facing rising premiums, deductibles, and copayments. The Affordable Care Act's tax credits make marketplace insurance more affordable for eligible lower-income individuals. However, individuals lose tax credits when their income exceeds 400 percent of the federal poverty level, creating a steep cliff. GOALS: To analyze the effects of extending eligibility for tax credits to individuals with incomes above 400 percent of the federal poverty level...
July 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28700190/getting-to-the-root-of-high-prescription-drug-prices
#12
Henry Waxman, Bill Corr, Kristi Martin, Sophia Duong
ISSUE: Historic increases in prescription drug prices and spending are contributing to unsustainable health care costs in the United States. There is widespread public support for elected officials to address the problem. GOAL: To document the drivers of high U.S. prescription drug prices and offer a broad range of feasible policy actions. METHODS: Interviews with experts and organizations engaged with prescription drug development and utilization, pricing, regulation, and clinical practice. Review of policy documents, proposals, and position statements from a variety of stakeholders...
July 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28641364/access-to-coverage-and-care-for-people-with-preexisting-conditions-how-has-it-changed-under-the-aca
#13
Sherry Glied, Adlan Jackson
ISSUE: Prior to the Affordable Care Act (ACA), people with preexisting health conditions could be denied insurance coverage or charged higher rates. If the law is repealed, these protections could be diluted or lost altogether. GOALS: Assess the ACA's impact on coverage and access for people with preexisting conditions and compare their coverage gains with state high-risk-pool enrollment pre-ACA. METHODS: Analysis of Behavioral Risk Factor Surveillance System data for the period 2011–13 to 2015. KEY FINDINGS AND CONCLUSIONS: Between 2013 and 2015, 16...
June 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28613067/the-american-health-care-act-economic-and-employment-consequences-for-states
#14
Leighton Ku, Erika Steinmetz, Erin Brantley, Nikhil Holla, Brian K Bruen
ISSUE: The American Health Care Act (AHCA), passed by the U.S. House of Representatives, would repeal and replace the Affordable Care Act. The Congressional Budget Office indicates that the AHCA could increase the number of uninsured by 23 million by 2026. GOAL: To determine the consequences of the AHCA on employment and economic activity in every state. METHODS: We compute changes in federal spending and revenue from 2018 to 2026 for each state and use the PI+ model to project the effects on states’ employment and economies...
June 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28613066/balance-billing-by-health-care-providers-assessing-consumer-protections-across-states
#15
Kevin Lucia, Jack Hoadley, Ashley Williams
ISSUE: Privately insured consumers expect that if they pay premiums and use in-network providers, their insurer will cover the cost of medically necessary care beyond their cost-sharing. However, when obtaining care at emergency departments and in-network hospitals, patients treated by an out-of-network provider may receive an unexpected "balance bill" for an amount beyond what the insurer paid. With no explicit federal protections against balance billing, some states have stepped in to protect consumers from this costly and confusing practice...
June 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28591975/an-overview-of-home-based-primary-care-learning-from-the-field
#16
Sarah Klein, Martha Hostetter, Douglas McCarthy
ISSUE: Homebound and functionally limited individuals are often unable to access office-based primary care, leading to unmet needs and increased health care spending. GOAL: Show how home-based primary care affects outcomes and costs for Medicare and Medicaid beneficiaries with complex care needs. METHODS: Qualitative synthesis of expert perspectives and the experiences of six case-study sites. FINDINGS AND CONCLUSIONS: Successful home-based primary care practices optimize care by: fielding interdisciplinary teams, incorporating behavioral care and social supports into primary care, responding rapidly to urgent and acute care needs, offering palliative care, and supporting family members and caregivers...
June 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28574235/how-arizona-medicaid-accelerated-the-integration-of-physical-and-behavioral-health-services
#17
Deborah Bachrach, Patricia M Boozang, Hailey E Davis
ISSUE: In most states, one agency has responsibility for Medicaid enrollees' physical health services and at least one other agency has responsibility for their behavioral health services. Apportioning responsibility for the physical and behavioral health of Medicaid beneficiaries into different agencies inevitably leads to different--and sometimes misaligned--policy goals, program priorities, and purchasing strategies, thereby impeding the delivery of integrated care. GOAL: To describe the rationale, process, and impact of Arizona's 2015 consolidation of its physical and behavioral health services agencies into its Medicaid agency...
May 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28574234/effect-of-the-affordable-care-act-on-health-care-access
#18
Sherry Glied, Stephanie Ma, Anais A Borja
ISSUE: The Affordable Care Act's (ACA) coverage provisions have extended health insurance coverage to millions of Americans. While the effects of the Medicaid expansion and marketplace establishments on coverage have been well studied, the resulting effects of coverage on access to health care remain unclear. GOAL: To examine how the 2014 coverage expansions affected health care access following the first open enrollment period of October 2013 to March 2014. METHODS: Analysis of data from the National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS)...
May 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28574233/the-impact-of-the-aca-s-medicaid-expansion-on-hospitals-uncompensated-care-burden-and-the-potential-effects-of-repeal
#19
David Dranove, Craig Gartwaite, Christopher Ody
ISSUE: By increasing health insurance coverage, the Affordable Care Act's Medicaid eligibility expansion was also expected to lessen the uncompensated care burden on hospitals. The expansion currently faces an uncertain future. GOAL: To compare the change in hospitals' uncompensated care burden in the 31 states (plus the District of Columbia) that chose to expand Medicaid to the changes in states that did not, and to estimate how these expenses would be affected by repeal or further expansion. METHODS: Analysis of uncompensated care data from Medicare Hospital Cost Reports from 2011 to 2015...
May 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28498650/medicare-beneficiaries-high-out-of-pocket-costs-cost-burdens-by-income-and-health-status
#20
Cathy Schoen, Karen Davis, Amber Willink
ISSUE: Fifty-six million people--17 percent of the U.S. population--rely on Medicare. Yet, its benefits exclude dental, vision, hearing, and long-term services, and it contains no ceiling on out-of-pocket costs for covered services, exposing beneficiaries to high costs. GOAL: To inform discussion of possible changes to Medicare, this issue brief looks at beneficiaries’ out-of-pocket costs by income and health status. METHODS: Spending estimates based on the Medicare Current Beneficiary Survey. FINDINGS AND CONCLUSION: More than one-fourth of all Medicare beneficiaries--15 million people--spend 20 percent or more of their incomes on premiums plus medical care, including cost-sharing and uncovered services...
May 2017: Issue Brief of the Commonwealth Fund
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