Reports & Analysis

A medical home is an enhanced model of primary care that provides whole person, accessible, comprehensive, ongoing and coordinated patient-centered care. First advanced by the American Academy of Pediatrics in the 1960’s, the concept gained momentum in 2007 when four major physician groups agreed to a common view of the patient-centered medical home (PCMH) model defined by seven “Joint Principles.” NASHP’s medical home map allows you to click on a state to learn about its PCMH efforts.

The following brief, prepared by experts at the University of Minnesota, provides background on data collected by the National Association of Insurance Commissioners (NAIC), including new types of data being collected for health reform monitoring purposes.  In its role as a regulatory support organization, the NAIC collects and compiles data from insurers classified as property and casualty, life, health, fraternal, or title insurers. In order to help regulators enforce the new provisions of the ACA, the NAIC teamed with HHS to design standard measures, definitions, and methodologies related to the regulatory targets of these provisions. This brief further explores the research opportunities (both within and across states) afforded by this new data being collected by the NAIC.

One of the major vehicles in the ACA to increase health insurance coverage is an expansion of Medicaid to adults with incomes at or below 138% of the federal poverty level (FPL). While the expansion was intended to be implemented in all states, as a result of the Supreme Court decision on the ACA, it is now effectively a state choice. As of July 1, 2013, 24 states are moving forward with the expansion, 21 states are not planning to move forward, and there is ongoing debate in 6 states. Based on an analysis of 2011 American Community Survey data, this brief examines the implications of current state Medicaid expansion decisions on coverage by race and ethnicity.

In this report, MACPAC examines several fundamental issues including Medicaid and CHIP eligibility and coverage for maternity services, the newly implemented increase in physician payment for primary care services, access to care for non-elderly persons with disabilities, the availability of Medicaid and CHIP data that can be used for oversight and program monitoring, and improving the effectiveness of program integrity activities.

The ACA includes Small Business Health Options Programs (SHOP) exchanges, intended to provide administrative relief and affordable coverage options to small employers across the country. This paper provides an overview of SHOP exchange development in six states. The six state based exchanges studied are all intending to offer employee choice in 2014 and report an encouraging amount of carrier interest. State contacts note that employer education is one of the major challenges they face, and outreach efforts to small businesses are just beginning.

This paper focuses on states' roles in implementation of FFEs. We start by providing an overview of recent regulations issued by CCIIO that describes the possible roles both for states and the federal government in the FFEs. We then provide in-depth descriptions of each of the specific FFE options as implemented in three states-Alabama, Michigan, and Virginia-with an eye to each state's role in developing mechanisms to carry out their new responsibilities and progress in creating relationships with the federal government in order to ensure successful implementation of the three types of federally facilitated exchanges.

This brief, prepared by Wakely Consulting Group, analyzes different options for premium rating methods for the Small Business Health Options Program (SHOP) Exchange.  The details of the billing/employer contribution approaches are explored and insights are given into the benefits and challenges of each method.  A key challenge in promoting employee choice in the SHOP is developing premium rating methods that do not discriminate against older employees, but that will support (a) employee choice of health plans based on value (including premiums), (b) a defined employer contribution, (c) a fair allocation of premiums among issuers, and (d) a premium invoice which employers can understand. This brief explores six options that SHOP exchanges can consider for resolving these issues.

The ACA will have important impacts on state Medicaid programs, likely increasing participation among populations that are currently eligible but not enrolled. The size of this “welcome-mat” effect is of concern for two reasons. First, the eligible but uninsured constitute a substantial share of the uninsured population in some states. Second, the newly eligible population will affect states’ Medicaid caseloads and budgets.

One of the objectives of the Affordable Care Act (ACA) reform of the nongroup insurance market, including new market and rating rules and reliance on public health insurance exchanges, is to enhance competition. More competing health plans increases consumer choice, as well as the market pressure on health plans to manage administrative costs, improve their service and contract with clinical providers at optimal rates. Especially in the context of health plans contracting selectively with providers in order to hold down payment rates, a choice of more health plans serves consumers well and signals a vibrant market. This brief, prepared by Wakely Consulting Group, provides an early indicator of the level of competition among health insurers that market reforms and state-based exchanges are generating.

Bundled payment is the concept of paying a fixed dollar amount to cover a set of services, as an episode of care over a defined period. Because of the fixed price, providers are encouraged to hold variable costs down; yet BP programs usually require providers to satisfy a minimum set of quality metrics in order to receive payment, thus ensuring providers do not skimp on care. This paper examines issues confronted by two AF4Q communities that are considering or implementing BP initiatives.