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Issue Brief of the Commonwealth Fund

Karen Davis, Amber Willink, Ian Stockwell, Kaitlyn Whiton, Julia Burgdorf, Cynthia Woodcock
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June 1, 2018: Issue Brief of the Commonwealth Fund
Nathan D Shippee, Katherine D Vickery
Issue: Access to health care, use of services, and patient outcomes can be complicated by many medical and nonmedical factors. People facing complex challenges such as mental illness, housing insecurity, or substance use, however, are not a homogeneous group; different individuals have different needs. Goals: To understand the needs of people with very low income--no more than 75 percent of the federal poverty level--who enrolled in Medicaid under Minnesota’s expansion of the program prior to the Affordable Care Act...
May 1, 2018: Issue Brief of the Commonwealth Fund
Stan Dorn
Issue: Consumers' concerns about affordability limit participation in ACA marketplaces. Funded by local hospital systems and run by independent nonprofits, third-party payment (TPP) programs improve affordability for low-income consumers by paying premium costs not covered by tax credits. Goal: To assess the potential of TPP to make marketplace coverage more affordable, without harming insurance risk pools. Methods: Interviews in May and June 2016 with program administrators, hospital systems, carriers, and consumer groups in five localities and the Washington State marketplace...
May 1, 2018: Issue Brief of the Commonwealth Fund
Henry Waxman, Bill Corr, Kristi Martin, Sophia Duong
Issue: Prescription drug prices have been climbing, creating significant barriers for patients. Since becoming U.S. Food and Drug Administration (FDA) Commissioner, Scott Gottlieb announced an action plan and several policy changes to increase generic drug competition and transparency to address high prescription drug prices. Goal: This issue brief aims to explain the FDA's plan of action and assess its implementation to date. It also aims to assess whether FDA actions, if implemented, address the known problems leading to high drug pricing...
April 1, 2018: Issue Brief of the Commonwealth Fund
Sherry Glied, Ougni Chakraborti
Issue: The Affordable Care Act (ACA) regulates the price of health plans sold in the nongroup market. Premiums cannot be based on gender or health status, and price increases related to age are limited. These changes have lowered premiums for older, sicker people but raised them for younger, healthier ones--especially young men ineligible for premium subsidies. This has raised concerns that the latter have failed to gain coverage. Goal: Compare the impact of the ACA's rating rules on the number of insured young men, older adults, and others...
April 1, 2018: Issue Brief of the Commonwealth Fund
Stuart Guterman, Laura Skopec, Stephen Zuckerman
Issue: Medicare Advantage (MA) enrollment has grown significantly since 2009, despite legislation that reduced what Medicare pays these plans to provide care to enrollees. MA payments, on average, now approach parity with costs in traditional Medicare. Goal: Examine changes in per enrollee costs between 2009 and 2014 to better understand how MA plans have continued to thrive even as payments decreased. Methods: Analysis of Medicare data on MA plan bids, net of rebates...
March 1, 2018: Issue Brief of the Commonwealth Fund
Jon R Gabel, Heidi Whitmore, Matthew Green, Sam Stromber
Issue: In 2017, five states--Alabama, Alaska, Oklahoma, South Carolina, and Wyoming--had only one issuer participating in their health care marketplaces, limiting consumer choice and competition among insurers. Goal: Examine the history of participation in the individual market from 2010 (before the Affordable Care Act was enacted) to 2017, and analyze premium changes among marketplace plans. Methods: Robert Wood Johnson Foundation's HIX Compare, which provides national data on the marketplaces from 2014 to 2017...
March 1, 2018: Issue Brief of the Commonwealth Fund
Amber Willink, Cathy Shoen, Karen Davis
Issue: The Medicare program specifically excludes coverage of dental, vision, and hearing services. As a result, many beneficiaries do not receive necessary care. Those that do are subject to high out-of-pocket costs. Goal: Examine gaps in access to dental, vision, and hearing services for Medicare beneficiaries and design a voluntary dental, vision, and hearing benefit plan with cost estimates. Methods: Uses the Medicare Current Beneficiary Survey, Cost and Use File, 2012, with population and costs projected to 2016 values...
January 1, 2018: Issue Brief of the Commonwealth Fund
Ruben Amarashingham, Bin Xie, Albert Karam, Nam Nguyen, Bianca Kapoor
Issue: Our health care and social services delivery systems are not well-equipped to effectively manage patients with multiple chronic diseases and complex social needs such as food, housing, or substance abuse services. Community-level efforts have emerged across the nation to integrate the activities of disparate social service organizations with local health care delivery systems. Evidence on the experiences and outcomes of these programs is emerging, and there is much to learn about their approaches and challenges...
January 1, 2018: Issue Brief of the Commonwealth Fund
Stephen Zuckerman, Laura Skopec, Stuart Guterman
Issue: Medicare Advantage (MA), the program that allows people to receive their Medicare benefits through private health plans, uses a benchmark-and-bidding system to induce plans to provide benefits at lower costs. However, prior research suggests medical costs, profits, and other plan costs are not as low under this system as they might otherwise be. Goal: To examine how well the current system encourages MA plans to bid their lowest cost by examining the relationship between costs and bonuses (rebates) and the benchmarks Medicare uses in determining plan payments...
December 1, 2017: Issue Brief of the Commonwealth Fund
Susan L Hayes, Sarah R Collins, David C Radley, Douglas McCarthy
Issue: Given uncertainty about the future of the Affordable Care Act, it is useful to examine the progress in coverage and access made under the law. Goal: Compare state trends in access to affordable health care between 2013 and 2016. Methods: Analysis of recent data from the U.S. Census Bureau and the Behavioral Risk Factor Surveillance System. Findings and Conclusions: Between 2013 and 2016, the uninsured rate for adults ages 19 to 64 declined in all states and the District of Columbia, and fell by at least 5 percentage points in 47 states...
December 1, 2017: Issue Brief of the Commonwealth Fund
Yash M Patel, Stuart Guterman
Issue: Since the 1980s, private plans have played an increasingly important role in the Medicare program. While initially created with the goals of reducing costs, improving choice, and enhancing quality, risk-based plans--now known as Medicare Advantage plans--have undergone significant policy changes since their inception; these changes have not always aligned with the original policy objectives. Goal: To examine major policy changes to Medicare risk plans and the effects of these policies on plan participation, enrollment, average premiums and cost-sharing, total costs to Medicare, and quality of care...
December 1, 2017: Issue Brief of the Commonwealth Fund
David Machledt
Issue: With its emphasis on coordinated care and prevention, managed care should be tailor-made to tackle social determinants of health. But various challenges discourage Medicaid health plans and providers from assisting beneficiaries with nonmedical concerns such as housing insecurity or parenting skills that are integral to improving health outcomes and lowering costs. To better address these social factors, the Centers for Medicare and Medicaid Services (CMS) updated its Medicaid managed care rule in early 2016...
November 1, 2017: Issue Brief of the Commonwealth Fund
Allen Dobson, Joan E DaVanzo, Randy Haught, Luu Phap-Hoa
Issue: Safety-net hospitals play a vital role in delivering health care to Medicaid enrollees, the uninsured, and other vulnerable patients. By reducing the number of uninsured Americans, the Affordable Care Act (ACA) was also expected to lower these hospitals’ significant uncompensated care costs and shore up their financial stability. Goal: To examine how the ACA’s Medicaid expansion affected the financial status of safety-net hospitals in states that expanded Medicaid and in states that did not...
November 1, 2017: Issue Brief of the Commonwealth Fund
Amber Willink, Karen Davis, John Mulcahy, Jennifer L Wolff
Issue: Older adults who reside in communities, as opposed to nursing homes or other residential institutions, are largely dependent on family and unpaid caregivers for assistance with daily activities, like preparing meals or laundry, and self-care tasks like bathing or dressing. For low-income older adults, assistance with such activities, also known as long-term services and supports (LTSS), can also come from Medicaid. These sources of support will be increasingly inadequate as the population ages...
November 1, 2017: Issue Brief of the Commonwealth Fund
Ted Robertson, Matthew Darling, Jennifer Leifer, Owen Footer, Dani Gordski
Issue: A deep understanding of human behavior is critical to designing effective health care delivery models, tools, and processes. Currently, however, few mechanisms exist to systematically apply insights about human behavior to improve health outcomes. Behavioral design teams (BDTs) are a successful model for applying behavioral insights within an organization. Already operational within government, this model can be adapted to function in a health care setting. Goal: To explore how BDTs could be applied to clinical care delivery and review models for integrating these teams within health care organizations...
November 1, 2017: Issue Brief of the Commonwealth Fund
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
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
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
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
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