Here is the amazing opening video from the 2015 PolicyLink Equity Summit, featuring Mayda del Valle:
This issue brief from the Center for Health Care Strategies describes the quality measurement approaches for accountable care organizations (ACOs) being implemented by Medicaid program in six states (Colorado, Maine, Minnesota, New Jersey, Oregon, and Vermont). The issue brief lists the specific quality measures that each of the states are using for their accountable care organizations, both for reporting and for calculating potential shared savings. The issue brief was funded by The Commonwealth Fund.
This issue brief from the Center for Health Care Strategies provides profiles of Medicaid programs in nine state (Colorado, Illinois, Iowa, Maine, Minnesota, New Jersey, Oregon, Utah, and Vermont) that are implementing accountable care organization (ACO) models. These Medicaid ACOs currently serve over two million Medicaid beneficiaries. The profiles describe payment models, quality measurement approaches, and data analysis strategies. Several additional state Medicaid programs are designing or preparing to implement a form of ACOs. The issue brief was funded by The Commonwealth Fund.
The Center for Health Care Strategies also has published a fact sheet with summary information about these state Medicaid ACOs.
The U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) has finalized the Comprehensive Care for Joint Replacement (CJR) model, to begin on April 1, 2016 (rather than January 1, 2016 in CMS’ proposed rule). The CJR model will test bundled payment and quality measurement for hip and knee replacements and/or major leg procedures to encourage hospitals, physicians, and post-acute care providers to work together to improve quality and coordination of care throughout an entire episode of care, from the initial hospitalization through recovery.
By holding participant hospitals accountable for episode spending and quality associated with services included in CJR episodes, hospitals will be encouraged to carefully consider the needs of each individual patient. Given this financial and quality responsibility, CMS anticipates providers will be motivated to engage in a number of quality improvements, such as better care coordination and improved care transitions between medical settings that result in better outcomes for Medicare beneficiaries. CMS will implement the proposed model in 67 geographic areas, defined by metropolitan statistical areas (MSAs). MSAs are counties associated with a core urban area that has a population of at least 50,000. The CMS program website has a list of the 67 MSAs. Approximately 800 hospitals in the 67 MSAs are required to participate in the CJR model. Hospitals outside the selected geographic areas are not able to participate. There is no application process for this model.
The CJR model has been designed by the CMS Innovation Center, which was established by section 1115A of the Social Security Act as amended by section 3021 of the Affordable Care Act. Congress created the CMS Innovation Center to test innovative payment and service delivery models to reduce CMS program expenditures and improve quality for CMS beneficiaries. The final rule will be published in the Federal Register on November 24, 2015. Below is a pre-publication version of the final rule.
The U.S. Department of Health and Human Services Office of Minority Health has released this implementation progress report on its Action Plan to Reduce Racial and Ethnic Health Disparities, which was adopted in 2011. Examples of progress are reported on activities addressing disparities in coverage and access to care, improving the quality of care, enhancing the diversity and cultural competency of the workforce, advancing community-based approaches to promote health and wellness, improving the quality and availability of data collected and reported on minority populations, and furthering research on racial and ethnic health disparities.
This issue brief from the Network for Regional Healthcare Improvement highlights how measurement of the total cost of care is a prerequisite for health care cost reductions. Total cost of care is defined as the cost to the purchaser of care – the individual or organization paying for health care services – not the cost to a provider to deliver the care. There are two primary components to measuring the cost of care: measuring service-specific utilization and service-specific price information. Measured separately, each of these components has significant limitations, but measured together, they create a powerful way to understand what is driving purchasers’ health care costs and how to reduce them or slow their growth.
The issue brief describes why most current methods of measuring cost of care are insufficient, and presents five core components for measuring, analyzing, and reporting the total cost of care, as well as the challenges associated with such measurement.
Efforts to generate measures and analyses to better understand total cost of care require all stakeholders – purchasers, payers/plans, and providers–to work in tandem. Collaboratives can combine health care claims data from multiple payers to generate measures of quality and utilization. They have existing processes in place to build consensus among providers and payers as to how measures should be defined and used; they have processes in place to enable providers to review and ensure the accuracy of measures before they are publicly reported; and they have programs to help providers redesign the way they deliver care to improve performance on the quality and utilization measures.
The issue brief provides some examples of early efforts in communities to develop and use total cost of care measures, what they are learning, and the challenges they are facing. The issue brief was funded by the Robert Wood Johnson Foundation.
This 2014 report from the Bipartisan Policy Center’s CEO Council on Health and Innovation describes strategies from America’s business leaders to improve the health and wellness of individuals, improve the health of communities, and improve the nation’s health care system. The members of the nine-member CEO Council on Health and Innovation are the chief executives from Aetna, Bank of America, Blue Cross and Blue Shield Association, Coca-Cola, Institute for Advanced Health, Johnson and Johnson, McKinsey, Verizon, and Walgreen. Together, their organizations employ nearly one million members of the U.S. workforce and are responsible for providing health insurance coverage to more than 150 million “covered lives” (employees, their families, and retirees covered by employer health insurance).
The sections of the report describe the challenges in improving the health and wellness of individuals, improving the health of communities, and improving the nation’s health care system, and how their companies are meeting those challenges. Among the strategies described are engaging employees in wellness programs, leveraging innovative uses of health information and communications technologies, building volunteerism among employees, re-prioritizing corporate philanthropy and community benefits, supporting practice improvements among contracted health care providers, applying business data analytics to health care, and participating in quality improvement and payment reform innovations such as accountable care organizations.
The CEO Council members call on the nation’s employers to join with them and commit to taking the following actions:
1. To improve the health and wellness of individuals, employers should implement comprehensive health and wellness programs for employees that address the following needs and begin tracking and sharing outcomes to promote learning and improvement:
2. To improve the health of communities, employers should begin to understand and support the health of communities by reviewing metrics already being captured in the following areas and collaborating with local public- and private-sector leaders on programs designed to promote improvements in any or all of the following:
3. To improve the health care system, employers should make value-based purchasing a factor in their choice of health plans for their employees and:
As the third open enrollment period under the Affordable Care Act begins, the New York Times has created interactive maps of the remaining uninsured in the U.S. (you can see the data for specific counties). The remaining uninsured are primarily in the South and the Southwest, and they tend to live in Republican-leaning states. In contrast, the rates of people without insurance in the Northeast and the upper Midwest have fallen into the single digits since the ACA was enacted. States that were late to expand Medicaid, including Pennsylvania and Indiana, also showed substantial reductions in their uninsured residents, compared with last year.
Enroll America, an organization devoted to finding uninsured people and signing them up for insurance worked with the data firm Civis Analytics to produce the maps. Enroll America used data from the U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation, updated as of July 2015.
“Shared value” is a concept that links social outcomes and economic results, or enhances the competitiveness of a company while simultaneously advancing the economic and social conditions in the communities in which it operates. Michael Porter of the Harvard Business School and Mark Kramer of FSG first wrote about the concept in an 2011 article in the Harvard Business Review. FSG is a nonprofit consulting firm specializing in strategy, evaluation, and research.
The Shared Value Initiative is a global community of practice to drive adoption and implementation of shared value strategies among leading companies, civil society, and government organizations. This report from the Shared Valued Initiative and FSG is based on consultations with over corporate leaders from pharmaceutical, medical device, nutrition, technology and telecommunications sectors as well as global health experts from government agencies, nongovernmental organizations (NGOs), and academic institutions about how best to measure shared value when applied to health solutions. The report was funded by Nestle, Novartis, and GSK.
Shared value is inherent in health technology companies (e.g., pharmaceutical and medical device industry), which create both economic and societal value when they provide products and services that tackle important health problems. This concept is becoming gradually more relevant to companies in other industrial sectors (e.g., nutrition, technology, and telecommunications), as firms seek to enhance their competitiveness by expanding their offering into health care.
Unmet health needs in a shared value context imply significant barriers at the customer level (e.g., low awareness of a condition or lack of acceptability of an intervention leading to poor adherence) and the inability of health care systems to deliver interventions in ways that customers can afford or accept (e.g., lack of financing mechanisms, inefficient supply chains). The shared value opportunity for companies lies in overcoming these barriers to meet unmet health needs profitably.
Shared value strategies include re-conceiving products and markets, re-defining productivity in value chains, and enabling local cluster development.
Among the findings in the report: