Reports & Analysis

In this report, the National Commission on Physician Payment Reform analyzes the factors contributing to the U.S.’s high health care spending, reviews how physicians are currently paid, and provides recommendations for reforming the physician payment system to drive higher quality and more cost-effective care.

The ACA expands Medicaid significantly beginning in 2014 and the expanded program is to serve as the foundation of the broader framework created by the ACA to cover millions of previously uninsured low-income adults and children. This primer examines how the Medicaid program is structured, who it covers, what services it provides, how it is financed, how much it costs, and how it will change under the ACA. 

This report examines the ACA’s 3:1 age rating band, which stipulates that premiums for adults age 64 can be no more than three times higher than the premiums for adults age 21 for the same coverage, and its impact on health insurance premiums. 

There are several different approaches to promoting patient-centered care: creating medical homes, helping patients to become partners in treatment decisions, and instituting payment reforms that enable doctors to be reimbursed for time spent counseling patients about healthy behaviors, for e-mail consultations, and for coordinating care with other providers. Little is known, however, about how health care organizations choose their approach and set goals. In this Commonwealth Fund–supported study, researchers interviewed health plan leaders and providers in Washington State, a leader in patient-centered innovation.

This report analyzes the early experiences of the State Action on Avoidable Rehospitalizations (STAAR) initiative, which is a program implemented in Massachusetts, Michigan, and Washington focused on reducing preventable hospital readmissions. Three key barriers to success were identified: 1) forming productive, collaborative relationships across care settings; 2) identifying effective interventions, especially across settings; and 3) addressing a lack of quality improvement capabilities among some health care providers. 

With new efforts underway to reform health insurance and improve quality, efficiency, and effectiveness of the U.S. health care system, assessing and planning for an adequate health care workforce is critical to meeting this evolving demands of the system. In this report, Deloitte Center for Health Solutions examines the health care worker demand projections and makes recommendations for modernizing the health care workforce planning framework.

State Refor(u)m has created a chart tracking states’ selection of vendors for their Exchange and/or Medicaid Eligibility and Enrollment IT systems and  the vendors’ roles in building these new systems. This chart also provides information on the software components that these vendors are using and whether states have brought on additional resources, such as developers, program management, and Independent Verification and Validation (IV&V) or Quality Assurance (QA) vendors.

Under the Affordable Care Act (ACA), there will be several changes to the Medicaid enrollment process in efforts to simplify it, including a single streamlined application. This report examines the propose paper-based application and 85 current printable Medicaid and CHIP applications, focusing on availability of application assistance, language accessibility, verification of income, verification of citizenship and immigration status and other messages for immigrant families, medical support requirements, and disability screening questions.

With the passing of the partnership deadline on February 15, 26 states have defaulted to the Federally Facilitated Exchange (FFE), and it will now be the responsibility of the Department of Health and Human Services to get the exchanges up and running in these states. This brief provides an overview of the requirements necessary to establishing a FFE and the challenges that the federal government may face in implementing them in 26 different states. 

This analysis was prepared to assist in planning for the design, implementation, and operation of a successful SHOP Exchange in New York State. It provides an overview of state and federal laws and regulations relating to the design and implementation of the SHOP; identifies potential options and decision points related to the design of the SHOP; summarizes other states' approaches to developing a SHOP; and provides a SHOP concept of operations, including the identification of key SHOP business processes.