The following is a list of all previous briefings for the year 2013. For briefings from other years, select from the list below.
|Am I in the Hospital or Not? Why Hospitals are 'Observing'--Not Admitting--Patients|
Friday, December 06, 2013
Increasingly, hospitals are observing, instead of admitting, Medicare beneficiaries, even when they are there for more than 48 hours. Health care experts say the situation is far from ideal for both hospitals and patients. Hospitals are feeling increased pressure from Medicare to classify patients the right way or risk losing reimbursements. In turn, patients face higher bills for services they receive in the hospital, and also the possibility of not qualifying for Medicare-covered nursing home care after their hospital stay.
|Health Insurance Marketplaces: The First 8 Weeks|
Friday, November 22, 2013
Health insurance marketplaces, or exchanges, opened October 1, and while states have released some enrollment data, and much of the attention has been on the initial technical challenges, there has been less information about overall consumer experience.
|Reference Pricing: Will Price Caps Help Contain Healthcare Costs?|
Monday, November 18, 2013
Many employers have begun to adopt a strategy known as “reference pricing” to help reduce health care costs. Under this benefit design, employees get insurance plans that set price caps on certain services and procedures. Enrollees are allowed to use any provider. But if they use providers with fees higher than the “reference price,” they must pay the difference between the reference price limit, determined by the employer or insurer, and the actual charge.
|Quality Care: Getting More Bang for the Buck?|
Friday, November 15, 2013
Health care policy leaders are counting on public and private initiatives, such as paying for performance, to improve value in the health care equation in which cost and quality at times seem to be at odds.
Health care costs are high and quality outcomes are low in several metrics, compared to other developed nations. And, studies have shown that costs vary among states and within states, and that regions with higher costs do not necessarily have higher quality.
|Pioneer ACOs: Lessons Learned from Participants and Dropouts|
Monday, September 23, 2013
More than a third of Pioneer ACOs succeeded in reducing costs in Medicare in their first year, according to a recent Centers for Medicare and Medicaid Services (CMS) report. The program initially saved Medicare about $87 million and cut Medicare spending by 0.5 percent.
|Telehealth and Telemedicine: Adopting New Tools of the Trade|
Friday, September 13, 2013
With millions of people projected to obtain health insurance coverage under the Patient Protection and Affordable Care Act (ACA), access to care is expected to be an issue. Efforts to promote telehealth and telemedicine could help.
In addition to electronic health records there is telestroke, teleICU and telepsychiatry. “Robodocs” have attracted recent media attention. Studies have shown these and similar tools to be effective in coordinating care and in saving time and saving lives in areas where access to services is scarce. Also, the Federation of State Medical Boards is formally exploring the creation of “interstate compacts” to increase efficiency in the licensing of physicians who practice in multiple states.
|Public Health Preparedness: Are We Ready for Disaster?|
Thursday, August 15, 2013
Following the terrorist attacks of September 11, 2001 and the subsequent anthrax assaults, the federal government began to reevaluate the nation’s preparedness for public health emergencies. Since then, the nation has been hit by massive floods, hurricanes and other disasters, and last year Hurricane Sandy swept up the east coast, crippling several states and nearly exhausting emergency services.
|"Rate Shock" -- Or Not?|
Tuesday, August 13, 2013
This Alliance for Health Reform webinar gave you the latest on what insurance rates will look like when state insurance exchanges open for enrollment on October 1.
A recording of the webinar is available here: http://www.windrosemedia.com/windstream/ahr081313/
|Health Insurance Marketplaces: Different Strokes for Different States|
Friday, August 09, 2013
The Patient Protection and Affordable Care Act (ACA) sets October 1, 2013 as opening day for enrollment in health insurance plans through marketplaces, or exchanges. The law allowed states to choose between running their own exchanges or having the Department of Health and Human Services (HHS) run a federally facilitated exchange.
HHS also created variations that allow states to take charge of some, but not all, exchange functions, in partnership with the federal government. The law also gave states some design flexibility. For example, states may decide how many plans participate on the exchange, how the exchange is governed and requirements for participation. This briefing will look at some of the choices states have made and the status of the exchanges in the three categories.
|Rural Reality: More Coverage, Enough Care?|
Friday, July 26, 2013
Sixty-two million Americans live in rural areas and they have higher rates of mortality, disability and chronic disease than their urban counterparts. With high poverty and unemployment rates, low rates of health insurance coverage and an undersupply of health care providers, the ills of the health care system are especially notable in rural communities. The Patient Protection and Affordable Care Act (ACA) contains provisions relating to access to care, coverage and delivery system reform. But the impact of these provisions is uncertain in rural America, with its unique challenges.
|Streamlining Cost Sharing in Medicare: The Impact on Beneficiaries.|
Monday, July 22, 2013
Recent proposals to combine the two main parts of Medicare would mean a single premium for beneficiaries. But, health care policy experts are cautioning that such a change is complicated and requires analysis. A July 22 Alliance for Health Reform briefing explored the impact on beneficiaries. The idea of redesigning Medicare’s benefits has gained increased attention from both Congress and the president in recent years. Medicare, with Parts A, B and D, has a complicated benefit structure, with various cost-sharing requirements and no limit on out-of-pocket spending. As a result, most beneficiaries in traditional Medicare have some form of supplemental insurance coverage (employer-sponsored retiree health plans, Medigap policies, or Medicaid) to help fill in the gaps.
|"The _____ (Doctor/Nurse/Other) Will See You Now": Rethinking Scope of Practice|
Wednesday, July 17, 2013
A July 17 webinar (1:00-2:30 ET) gave you the latest on a flurry of state legislation to allow nurses, nurse practitioners and other medical providers to do more to care for patients.
|Shifting Challenges: Mental Health in the ACA Era|
Tuesday, July 02, 2013
Provisions of the 2010 health reform law, combined with mental health parity legislation, promise to make mental health care available to millions more Americans in 2014 through both private insurance and Medicaid. But, the sweeping changes that these laws make to financing for mental health care will require states, mental health providers, private insurers and patients to make major adjustments.
|The Future of Medicare Advantage: Are We on the Right Path?|
Monday, June 10, 2013
Big changes are coming to Medicare Advantage, through which 28 percent of Medicare beneficiaries now get coverage in such private health plans as HMOs and PPOs. A June 10 Alliance briefing looked at the program's chances for survival and growth. The Patient Protection and Affordable Care Act (ACA) reduced payments to Medicare Advantage plans to bring them more in line with costs under traditional Medicare. So far, however, the effects of those reductions have been offset by quality bonus payments. Also, CMS announced a change in the assumptions that results in a 3.3 percent payment increase for health plans for 2014 instead of a scheduled 2.3 percent payment reduction.
|Medicare for the 21st Century|
Monday, June 03, 2013
Can Medicare be sustained in a climate of high and rising health care costs? Are there proposals that might improve quality of care while containing costs? A June 3 briefing, Medicare for the 21st Century, will address the sustainability of Medicare under its current design. A panel of Medicare experts reviewed proposals and provided perspectives on modernizing Medicare to improve the efficiency of the program, improve the quality of care and reduce overall health care costs.
|Worker Wellness Programs: Do They Work?|
Friday, May 31, 2013
Starting in 2014, employers will be allowed to charge their workers up to 30 percent more for health insurance premiums if they don't meet certain health goals, under the Patient Protection and Affordable Care Act (ACA). An Alliance for Health Reform briefing, Worker Wellness Programs: Do They Work? explained the provisions in the law, and examined employer efforts to improve worker wellness, along with evidence about savings. What effect can tying wellness incentives to premiums have on workers, and especially less healthy workers? What does the evidence say about wellness programs and costs? Under the proposed agency rules related to the ACA provisions, what would be permitted and not permitted in wellness program design and practice? What are key concerns about implementing such programs? A distinguished panel of experts addressed these and related questions.
|Medicare-Medicaid Coordination for Dual Eligibles: What’s it All About?
Monday, May 13, 2013
Over nine million Americans receive benefits from both Medicare and Medicaid costing over $315 billion in health care services in the two programs combined. The dual eligibles account for 15 percent of the Medicaid population and almost 40 percent of all Medicaid expenditures for medical services; and 20 percent of the enrollees in Medicare, but 30 percent of the expenditures. Who are the dual eligibles? How does the Patient Protection and Affordable Care Act (ACA) address cost and quality of health care issues for this population? What is the office of duals? What federal initiatives are helping to improve quality, integrate care and align financing? How are the states involved in serving dual eligibles? In improving their care and coping with the high cost of care? What do the demos hope to show?
|Patient-Centered Medical Homes: Do They Work?|
Friday, May 03, 2013
The patient-centered medical home (PCMH), also referred to as the primary care medical home, is a model that aims to transform the organization and delivery of primary care. Why are we investing in testing the patient-centered medical home model? What does current evidence say about the impact of PCMH models? Can these models generate savings for the health care system down the road? Do primary care practices have the capacity and time to develop these models? What resources are necessary to ensure a functioning PCMH? What is the status of the demonstration projects run under CMMI? What are some successes and challenges that active PCMHs have encountered? How else does the ACA provide support for patient-centered medical homes? A distinguished panel of experts addressed these and related questions.
|ACA 101: What You Need to Know|
Friday, April 26, 2013
States and the federal government must be ready to begin enrolling millions of people in insurance marketplaces in October of this year. By January 1, most Americans will have to have health coverage or pay a penalty. Most states are also expected to draw new federal money to significantly expand their Medicaid programs. Insurers, meanwhile, face new rules, and doctors, hospitals and other medical providers will experiment with payment models intended to encourage quality instead of volume when it comes to care. This briefing will be especially helpful to congressional staff members and others with limited knowledge of the Patient Protection and Affordable Care Act (ACA), but it will also be a useful review for anyone dealing with the complex issues leading up to major changes scheduled to take effect in 2014.
|Price and Quality Transparency: Tools for Informing Health Care Decisions|
Friday, April 19, 2013
The Patient Protection and Affordable Care Act (ACA) calls for increased consumer involvement in health care decision-making. Transparency in price and quality as a tool for consumer engagement is a critical component of that process. One does not buy food, clothing or housing without comparison shopping. Yet in health care, equally important and typically a large part of the family budget, consumers have not had the tools to compare prices and quality of the product they are buying. The data are spotty and the little data that are available are not consumer friendly. What tools are needed to compare price? Quality? What does the ACA require with regard to transparency? Will consumers have the information they need to compare products on state-based insurance exchanges? Are the data available? In a consumer friendly format? What kinds of information in addition to price do consumers need to make choices between various treatment options or to choose a care provider?
|The Health Care Workforce: Prescription for the Future |
Friday, March 22, 2013
The Patient Protection and Affordable Care Act (ACA) has the potential to greatly increase the number of insured people and change how health care services are delivered. What the additional coverage will mean regarding access to providers, who those providers will be and what services they will deliver are issues that affect all segments of the health care workforce.
|The Doc Fix: What Happens Next?|
Friday, March 15, 2013
Proposals to fix the Sustainable Growth Rate (SGR) abound and there is agreement that policy makers must take action, but the question of how to reach a permanent solution remains. The SGR originated as part of the Balanced Budget Act of 1997 to control federal Medicare spending. Congress began overriding the SGR in 2002 and has continued to delay scheduled physician reimbursement cuts ever since. Medicare physician payments were maintained at their current rates in 2012 as a result of The Middle Class Tax Relief and Job Creation Act of 2012. Most recently, Congress extended payment rates until January 2014 as part of the “fiscal cliff” negotiations.
|Medicaid 101: What You Need to Know|
Friday, March 01, 2013
A March 1 briefing, Medicaid 101: What You Need to Know, was especially helpful to congressional staff members and others new to the issue, but was also a useful review for anyone dealing with Medicaid issues, particularly as many states prepare to expand their programs.
|Medicare 101: What You Need to Know|
Monday, February 11, 2013
A February 11 briefing, Medicare 101: What You Need to Know, was especially helpful to congressional staff members and others new to the issue, but it was also a useful review for anyone dealing with Medicare issues, particularly as pressure intensifies to slow the growth of program spending. Medicare provides health care coverage to 50 million individuals ages 65 and over, and to younger people with permanent disabilities. The federal government currently devotes 15 percent of its budget to the program. This Medicare 101 answered basic questions about the program.
|Approaches to Bending the Health Care Cost Curve|
Monday, January 28, 2013
While health spending as a share of GDP remained steady at 17.9 percent from 2009 through 2011, some analysts warn that, as the economy improves and the population ages, cost increases could again accelerate. Are there changes to the health law that could slow down health care spending growth? How can the public and private sectors collaborate to effectively address the problem? What role can market-based incentives and reforms play in a solution? Are there examples of provider payment or delivery innovation that could help? Should spending targets be established? If so, how? What are other approaches to stabilizing health care spending? Stu Guterman of The Commonwealth Fund, Karen Ignagni of America’s Health Insurance Plans and Robert Galvin of Equity Healthcare at the Blackstone Group addressed these questions.