Reports & Analysis

Across the nation, public and private payers are combining forces to encourage providers in a given health care market to deliver more efficient, higher quality care. Payers can align on several fronts, including payment policies, quality measurement, administrative practices, and data-sharing. Drawing from the efforts of three state innovators (Maine, Vermont, and Wisconsin), this brief outlines promising strategies for quality measurement alignment across purchasers as a means to improving delivery system performance. The lessons can inform Medicaid and private purchasers in advancing a joint quality strategy.

Recognizing that health is determined by a variety of interrelated factors, states are looking to connect health care, public health, and social services to help achieve improved population health, better care, and reduced cost of care. This issue brief describes three essential components for integrating health, including physical and behavioral health, public health, and social services: 1) a coordinating mechanism, 2) quality measurement and data-sharing tools, and 3) aligned financing and payment. It also presents a five-step policy framework to help states move beyond isolated pilot efforts and establish the infrastructure necessary to support ongoing integration of health and social services.

Safety-net hospitals have long played an important role in the U.S. health care system in serving vulnerable populations, providing high cost services, and training medical and nursing students.  However, under the ACA, safety-net hospitals now face challenges competing for newly insured patients and continuing to serve the remaining uninsured (including adults in states not expanding Medicaid and undocumented immigrants who remain ineligible for Medicaid or new ACA coverage). They also face reductions in financing for uncompensated care. This brief examines four safety-net hospitals to learn how they were preparing for the full implementation of health reform, in order to gain additional insight into the strategies being used and challenges being faced among safety-net hospitals across the country.
 

A new Commonwealth Fund survey finds that in the wake of the ACA’s first open enrollment period, significantly fewer working-age adults are uninsured than just before the sign-up period began, and many have used their new coverage to obtain needed care. The uninsured rate for people ages 19 to 64 declined from 20 percent in the July-to-September 2013 period to 15 percent in the April-to-June 2014 period. An estimated 9.5 million fewer adults were uninsured. By June, 60 percent of adults with new coverage through the marketplaces or Medicaid reported they had visited a doctor or hospital or filled a prescription; of these, 62 percent said they could not have accessed or afforded this care previously.

Fast-track enrollment strategies do more than help people sign up for Medicaid—they save states money. These strategies speed up the eligibility process by allowing states to use information they already have on file from other public benefit programs. By vastly reducing the time eligibility workers spend processing Medicaid applications, fast-track strategies can reduce administrative expenses. This brief examines the costs and savings of two states—West Virginia and Illinois—implementing fast-track enrollment in Medicaid.

Medicaid is the largest health insurance program in the United States, covering both acute and long-term care services for over 66 million low-income Americans—children and their parents, as well as elderly and disabled individuals. This report focuses on the impact of Medicaid on the states, including trends in spending and enrollment, and the anticipated effects of the ACA.
 

The Affordable Care Act (ACA) contains numerous consumer protections designed to remedy shortcomings in the availability, affordability, adequacy, and transparency of individual market insurance. However, because states remain the primary regulators of health insurance and have considerable flexibility over implementation of the law, consumers are likely to experience some of the new protections differently, depending on where they live. This brief explores how federal reforms are shaping standards for individual insurance and examines specific areas in which states have flexibility when implementing the new protections

All-payer claims databases (APCDs) collect and compile medical, pharmacy, and sometimes dental claims, eligibility, and provider files from public and private payers. APCDs are currently being used for a variety of functions, including population health analysis, comparative analysis of provider and facility quality, cost management for Medicaid and other public programs, support for provider payment reform initiatives, and consumer transparency tools. This issue brief explains the potential uses of APCDs for rate review and other regulatory functions. It includes descriptions of possible uses for APCDs and ranks the level of effort necessary to use an APCD for those purposes, along with the relative value of doing so.

The Agency for Healthcare Research and Quality has published the eighth Evaluation Highlight from the CMS-funded CHIPRA Quality Demonstration Grant Program. This Highlight focuses on how Colorado and New Mexico have helped school-based health centers (SBHCs) strengthen their patient-centered medical home (PCMH) features. It describes what motivated these states and SBHCs to adopt the PCMH model and how other states can support SBHCs in becoming medical homes
 

The health care affordability crisis is causing unprecedented changes in the health care landscape, the most significant of which is the transition from the current volume-based model to myriad models based on measures of value. This white paper outlines the challenges involved with performing population-level analyses, developing cost accounting and profitability analyses across care settings, evaluating care episodes and integrating quality data. It explores the limitations of targeted software solutions to provide cross-enterprise insights. Finally, it provides advice for healthcare executives regarding how to approach gathering quality and cost-related data and leverage technology and analytical expertise to drive risk-based contract success.