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Past Briefings

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The following is a list of all previous briefings for the year 2014. For briefings from other years, select from the list below.

Between Two Worlds: Adolescents and our Health Care System
Monday, December 15, 2014

Adolescence is a time of physical, emotional, and cognitive transition between the worlds of childhood and adulthood. This time can include the onset of chronic conditions such as obesity, hypertension, and schizophrenia, yet teens may have difficulty accessing appropriate care for their physical and mental health needs. Emerging models around the country may be improving adolescents’ access to appropriate care, but the evidence suggests many needs are not being met.

Digital Health Innovations: Engaging the Patient and Transforming Health Care Delivery
Monday, December 08, 2014

Digital health technologies, particularly those designed to engage and empower patients, have the potential to address unmet health needs and deliver care in new, lower-cost ways. Information shared from electronic health records, the “cloud” and apps can help clinicians target conditions, measure and monitor patient outcomes, personalize treatments, and engage patients in their care. This briefing will examine innovative uses of digital health technology to engage patients and deliver care, with particular focus on high cost, high need patients.

Medicare Advantage in a Changing Health System
Friday, December 05, 2014

Almost three in ten Medicare beneficiaries are enrolled in the Medicare Advantage (MA) program, which offers a choice of competing private health plans – typically managed care plans such as HMOs and PPOs. The Affordable Care Act (ACA) made significant changes to the way Medicare Advantage plans are paid, including tying a portion of payments to a quality star rating system. Despite predictions that MA enrollment would drop in the wake of scheduled payment reductions to the program, the percentage of seniors who are choosing to enroll in MA plans is still growing. However, the impact of upcoming reductions remains the subject of much debate.

ACA Enrollment Round II: Do Consumers Have the Help they Need?
Tuesday, December 02, 2014

The Affordable Care Act’s second open enrollment period runs through mid February, and millions of people are already looking for help to find the best insurance fit. While many who signed up last year are expected to shop around for different health plans, millions more may become first time buyers.

Webinar- Regulating Network Adequacy: The New NAIC Model
Wednesday, November 19, 2014

With the launch of the Affordable Care Act’s second open enrollment period this week, millions of people are again expected to flood marketplace websites to enroll or reenroll in health plans. At the same time, insurance commissioners are announcing draft regulations to help their states respond to an issue that was the subject of major controversy during the first round of enrollment: Some of the new health plans are offering consumers networks that exclude certain doctors, hospitals and other medical providers. Some claim that these networks hamper provider access and choice; others contend that this approach, if done the right way, helps consumers by creating competition and controlling costs, without compromising the quality of care.

Curbing The Ebola Outbreak: Are We on the Right Track?
Tuesday, November 18, 2014

The World Health Organization (WHO) recently declared a public health emergency due to the Ebola virus outbreak in West Africa, which has accounted for over13,000 reported cases and 4,800 deaths. Some imported and locally acquired cases in health care workers have also been reported in the United States. As a result, concerns about the further escalation of this epidemic and how to best prepare for and contain this deadly disease exist in both the U.S. and abroad.

Health Insurance Marketplaces, Round II: Results and Expectations
Friday, November 14, 2014

One day after this briefing, on November 15, the second open enrollment period begins for health plans sold in federal and state marketplaces. More than 7 million people who bought insurance for 2014 can shop around for new plans or stay where they are. Those who received federal subsidies will face a redetermination process to assess their current income and other eligibility factors. Experts estimate there may be millions of new enrollees.

21st Century Cancer Care: Will New Models Lead to Better Care at Lower Cost?
Friday, November 07, 2014

The United States spends more than $125 billion annually on cancer care. By 2022, there will be 18 million people with cancer and by 2030 cancer incidence is expected to rise by 2.3 million new cases per year. The high cost of cancer drugs and the “buy and bill” model of paying for them under Medicare have received significant attention. But other factors, such as highly-variable practice patterns and a lack of meaningful engagement of patients in care decisions, have also been called into question.

Incentives 2.0: Is Paying for Performance Enough?
Tuesday, October 14, 2014

Every day, health care professionals make complex decisions that directly affect the cost and quality of care. Increasingly, both private and public payers are implementing payment reforms to motivate quality improvement, reward providers for delivering high quality care, and, in some cases, impose penalties for sub-par performance, while bipartisan policy proposals to reform Medicare physician payment would modify existing provider incentive programs.

Prescription Opioid Abuse: Fighting Back on Many Fronts
Monday, September 29, 2014

According to the Centers for Disease Control and Prevention (CDC), drug overdose is the leading cause of injury death in the United States. In 2010, opioid pain relievers accounted for approximately 17,000 of overdose deaths— more than twice the number of deaths from cocaine and heroin combined. Despite the tremendous importance of prescription drugs in treating pain, some medications have a high risk of being misused or abused. Some researchers have voiced concerns that prescription painkillers could even be a gateway drug for heroin users. With the steady rise in prescription rates and drug overdose deaths, policymakers are coming to a consensus that this national problem must be addressed.

Network Adequacy: Seeking Balance
Friday, September 26, 2014

Some new health plans sold in the insurance marketplaces are offering consumers networks that exclude certain doctors, hospitals and other medical providers. While some claim that these networks hamper provider access and choice, others contend that this approach, if done the right way, helps consumers by creating competition and controlling costs.

Navigating the Health Insurance Landscape: What’s next for Navigators, In-person Assisters and Brokers?
Tuesday, August 05, 2014

Approximately10.6 million people were aided by more than 4,400 in-person assistance programs in searching and applying for coverage in the first six-month enrollment period. Brokers also played a role in helping consumers sign up for coverage. Some believe that in-person, enrollment assistance programs are key to future enrollment success, while others voice concerns about the training of those offering assistance, and the security of applicants’ personal information. Many questions arise about their effect on coverage moving forward and the funding required to support the programs.

Health Care Behind Bars: A Key to Population Health?
Friday, August 01, 2014

This briefing will explore innovations and challenges in delivering health care to a growing population of inmates. This is an expensive group because of the large number of people with mental illness, addiction disorders, conditions associated with aging and Hepatitis C. Indeed, corrections spending is the second fastest-growing state expenditure, behind Medicaid, according to the Pew Charitable Trusts.

Disclosure and Apology: A Win-Win for Patient Safety and Medical Liability?
Monday, July 28, 2014

Policymakers, providers, and stakeholders have been debating various approaches to reforming our medical liability system to both protect patients who experience adverse medical events and to help practitioners provide the highest quality care possible. One innovative approach may well avoid some of the sharper policy differences on proposals in this area: encouraging the disclosure of unanticipated outcomes to affected patients. This disclosure may include an explanation and apology to the patient and family, as well as an offer of compensation in some cases. Some anecdotal data suggest that such communication-and-resolution programs can result in improved patient safety and decreased malpractice claims. However, questions arise about how well this approach really works, and whether it can be standardized and scaled up in our medical system.

Network Adequacy: Balancing Cost, Access and Quality
Monday, July 21, 2014

Some new health plans sold in the insurance marketplaces are offering consumers networks that exclude certain doctors, hospitals and other medical providers. While some claim that these networks hamper provider access and choice, others contend that this approach, if done the right way, helps consumers by creating competition and controlling costs.

Children’s Health Coverage: What You Need To Know
Monday, July 14, 2014

Approximately 8 million children with low to moderate incomes are covered under the Children’s Health Insurance Program (CHIP) and 39 million children are covered under Medicaid. (Most children who have coverage have private coverage). The number of uninsured children has decreased by half since the enactment of CHIP in 1997; however, with a new coverage landscape and CHIP funding set to expire in October 2015, questions arise about the current state and future of children’s health care coverage.

Health Insurance Marketplaces in 2014: Behind the Numbers
Friday, July 11, 2014

With the first open enrollment period for health insurance marketplaces now completed, an estimated 8 million people have enrolled in new private health insurance plans, with millions more newly enrolled in Medicaid. This briefing will look behind the enrollment numbers to take a detailed look at the demographics of marketplace enrollees, initial consumer experiences with health plans and lessons for next year’s open enrollment period.

Rates of Change: Putting 2015 Insurance Premiums into Context
Friday, June 27, 2014

Health insurance premiums have been one of the most closely-watched features of the new health insurance marketplaces. In 2014, insurers set rates based on limited data about who would sign up for coverage. Round II of open enrollment is fast approaching, allowing little time to process the first year’s data and to prepare for tomorrow. For 2015, some analysts anticipate increases of 10 percent or less, while others forecast growth of 20 percent or more.

Patient-Centered Medical Homes: The Promise and The Reality
Friday, May 30, 2014

While the Patient-Centered Medical Home (PCMH) model has increasingly been embraced by providers and payers as a way to improve health care and lower costs, many questions remain about its effectiveness. Definitions of medical homes vary, but they are generally known as a model that aims to transform primary care through increased coordination and communication among a team of providers.

Health Centers at the Launch of the Coverage Expansion
Friday, May 16, 2014

The coverage expansion under the Affordable Care Act brings new pressures and opportunities for health centers, including the potential to serve newly-insured patients while continuing as a cornerstone of the primary care safety net for the uninsured. At the same time, health centers are in the midst of rapid transformation brought about in part by recent federal investments in health center capacity and delivery system improvements, even as they face uncertainty about future state and federal funding.

State Medicaid Expansion: The Third Way
Monday, May 12, 2014

To date, about half of states have moved forward with the Affordable Care Act’s optional Medicaid expansion. Now, additional states are pursuing an altogether different path that would allow them to use federal Medicaid funds to help low-income residents buy private coverage. Arkansas, Michigan and Iowa have already received federal Medicaid waivers and launched programs. Others are in various stages of drafting and negotiating. A few are considering block grants.

Is the Mind Part of the Body? The Challenge of Integrating Behavioral Health and Primary Care in a Reform Era
Friday, May 02, 2014

As more people gain coverage that includes behavioral health benefits, and given a limited supply of mental health professionals, analysts and advocates are raising concerns over how and whether new laws and regulations will be able to change that situation. One option being explored in many settings is the integration of behavioral health services with primary care. There is early evidence that coordinating care in this manner may deliver high-quality care more efficiently.

What’s Preventing Prevention?
Thursday, April 17, 2014

Preventive services were a priority in the Patient Protection and Affordable Care Act (ACA), which required that a set of services be available to consumers with no cost sharing. This has improved access for some people to some services. But persistent barriers for consumers are limiting the utilization of preventive services. These barriers include the variability of insurance coverage, the affordability of out-of-pocket costs, the challenges of education and outreach, and the funding of public health initiatives.

Beyond the SGR: Alternative Models
Friday, January 24, 2014

Congress is as close as it has ever been to scrapping the Medicare sustainable growth rate (SGR) for an alternative system of paying doctors based on the quality - rather than the quantity - of services.

Healthier and Wealthier, or Sicker and Poorer? Prospects for Medicare Beneficiaries Now and in the Future
Monday, January 13, 2014

Although Medicare reform is not currently a front-burner issue, proposals to reduce Medicare spending appear regularly on the policy agenda. Various Medicare savings proposals have recently emerged in the context of efforts to control the national deficit and debt, and could arise in the next few months when Congress considers how to modify Medicare’s physician payment policy to avoid a precipitous reduction in physician fees. The recently passed bipartisan budget deal delayed a reduction in Medicare payments to physicians until April, and any effort to permanently replace the existing system by which Medicare pays physicians will be costly.

 


Uwe Reinhardt Questions Bundled Payment Savings Prospects


Video (2:58)

A new Alliance for Health Reform video features Princeton’s Uwe Reinhardt questioning whether bundling payments for medical services might actually lead to higher – not lower – costs.

"The ACO's, the accountable care organizations, could create local monopolies that could dictate to you what that bundled price would be, and some of us fear that bundled prices might be even more than what the fee-for-service for that bundle would be today. … You really should align all the payers and say, 'Let us jointly negotiate with the ACOs what those bundles should be so that they cannot divide and rule and sort of make us on the buy side weak.'"

FULL TRANSCRIPT

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Sister Carol Keehan on Health Law Enrollment Challenges this Year


Video 3:00

A new Alliance for Health Reform video features Sister Carol Keehan of the Catholic Health Association of the United States addressing the challenges of quickly enrolling millions of Americans for health insurance this fall. Open season begins October 1 of this year, yet she says that up to 85 percent of those who will be newly eligible for Medicaid or for subsidies to buy private insurance in state-based exchanges don't know it.  FULL TRANSCRIPT

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Jonathan Blum on CMS Efforts to Keep Medicare Spending Growth Down


Video (2:54)

Jonathan Blum, acting principal deputy administrator and director of the Center for Medicare at the Centers for Medicare and Medicaid Services (CMS), addresses the slower growth of Medicare spending over the last few years, and what his agency is doing to try and continue the trend. “There are promising signs that this strategy to change the payment system, to change the payment models, to focus on waste and abuse, is paying off," he said. "We are taking a whole new approach to addressing fraud in the program. Much more data resources, much more on the ground reaction. We have seen dramatic spending declines in areas of spending, such as home health and durable medical supplies that historically fueled lots of the fraud.”  FULL TRANSCRIPT

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Two Former Medicare Administrators Discuss How to Save the Program


A new Alliance for Health Reform video features two former Medicare administrators -- Gail Wilensky and Bruce Vladeck -- on their ideas about how to save the program.

Ms. Wilensky, who ran Medicare in a Republican administration, argued for increasing the eligibility age of Medicare for future retirees, while still making the program available at age 65 for those who are disabled.

Watch at http://www.youtube.com/watch?v=GQjsfam9-w0

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Douglas Holtz-Eakin: Health Care Spending Lull Only Temporary


Video (3:11)

A new Alliance for Health Reform video features Douglas Holtz-Eakin of the American Action Forum, and a former director of the Congressional Budget Office, arguing that recent slower spending growth in health care won’t continue.

"We also saw a slowdown in the mid-90s, and we all declared victory and it came right back. I think next year we’ll see a noticeable uptick. There will be lots of new people entering the insurance markets because of the exchanges and the subsidies that come along with them, and those subsidies are very generous. … These are an invitation for people to get coverage and to buy more health care. I think that’ll place a lot of pressure on spending."

FULL TRANSCRIPT

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Marketplace Enrollment Helpers Toolkit


Beginning October 1, insurance marketplaces open for enrollment, and millions of people will be eligible to purchase plans. To guide them in the application process, the federal government has invested in programs to train community organizations and hired staff.

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The Employer Mandate of the Patient Protection and Affordable Care Act


The Toolkit, available here, details the ACA’s employer requirements and penalty. It also includes information about the delay in the mandate to 2015, and analysis about its impact on employer-based coverage.

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Toolkit: Training the Workforce for a Changing Health System


A new Alliance for Health Reform toolkit addresses concerns about whether newly-trained physicians are adequately prepared for today's evolving health care delivery system. Does training adequately emphasize care coordination, team-based care, costs of care, health information technology, cultural competence and quality improvement? Does it encourage students to practice in a primary care setting?

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Toolkit: Emergency Preparedness in the U.S.: The Ebola Threat


Is the U.S. prepared for a potential virulent pandemic? This new Alliance toolkit examines public health infrastructure, funding and policy levers that deal with these kinds of health crises in America.

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