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THIS WEEK ON THE BLOG

HEALTH REFORM

The ACA At 10: Health Care Revolution
By Ezekiel J. Emanuel and Abbe R. Gluck (2/28/20)

How should we evaluate the ACA decade? We invited an all-star group of former government officials, lawyers, commentators, and highly respected academic researchers to evaluate the impact of the ACA and speculate about the future. This series of blog posts represents some of the responses. This post discusses the contents of the blog series as well as the thoughts of other authors included in the forthcoming book The Trillion Dollar Revolution. Read More >>

Present At The Creation: Launching The ACA—2010 To 2014
By Kathleen Sebelius and Nancy-Ann DeParle (2/28/20)

The ACA is not perfect—no major law is—but it was worth fighting for. Read More >>

SYSTEMS OF CARE

Slouching Towards Disruptive Innovation
By James C. Robinson (2/28/20)

Clay Christensen, perhaps the most influential business school professor of our era, passed from the world earlier this year. Christensen articulated the concept of "disruptive innovation," in which outsiders with low-performance but low-price products compete for consumers poorly served or not served at all by industry insiders, and then gradually improve performance while retaining lower prices and thereby seize the heights as well as the depths of their markets. Read More >>

DETERMINANTS OF HEALTH

Addressing Social Determinants: Scaling Up Partnerships With Community-Based Organization Networks
By Lance Robertson and Bruce Chernof (2/24/20)

As health care payment models become more value-based, health care systems are increasingly interested in approaches that address both medical needs and social determinants of health. Read More >>

CULTURE OF HEALTH

Discrimination: A Social Determinant Of Health Inequities
By Brigette A. Davis (2/25/20)

This post examines the unique role of discrimination as a stressor and the part it plays in creating health inequities. Read More >>

Stress Is A Key To Understanding Many Social Determinants Of Health
By Aric A. Prather (2/24/20)

It is clear that the social conditions in which people live are fundamental in shaping health trajectories, and that the stress created through these social conditions serves as an important pathway driving poor health and furthering health disparities. Read More >>

MATERNAL AND CHILD HEALTH

Understanding The Impact Of Prenatal Care: Improving Metrics, Data, And Evaluation
By Rebecca A. Gourevitch, Alex Friedman Peahl, Margaret McConnell, and Neel Shah (2/26/20)

Understanding the role of prenatal care in maternal and infant well-being will require developing more meaningful quality metrics, leveraging new data sources, and finding new and creative ways to conduct evaluations with careful attention to selection bias.
Read More >>

MEDICAID

Medicaid Medical Directors Have A Front Row Seat To The Maternal Mortality Crisis. Here’s What They’re Focused On
By Susan Kennedy and Sunita Krishnan (2/27/20)

As states are addressing the maternal mortality crisis, Medicaid medical directors and Medicaid agencies are primed to assist in implementing innovative strategies to ensure the safety and well-being of women and their infants. Read More >>

Five Ways Medicaid Expansion Is Helping Homeless Populations Ten Years After The ACA Became Law
By Barbara DiPietro (2/27/20)

Our health care system is capable of helping prevent and end homelessness, and Medicaid expansion is central to that effort. Read More >>

HOMELESSNESS

The Emerging Crisis Of Aged Homelessness: What Can Be Done To Help?
By Brian Byrd

The homeless population is "greying" in New York City, Boston, and Los Angeles, University of Pennsylvania researchers have found. New York City is in the middle of an emerging crisis of aging homelessness, according to their 2019 report. At a panel discussion hosted by a foundation, they projected that costs for shelter, hospital, and nursing home services for the elderly homeless just in that city will reach about $460 million a year by 2030. What interventions can help that population and maybe save money? Read More >>

HEALTH INFORMATION TECHNOLOGY

To Measure The Burden Of EHR Use, Audit Logs Offer Promise—But Not Without Further Collaboration
By Genna Cohen, Llewelyn Brown, Megan Fitzgerald, and Anita Somplasky (2/28/20)

Additional efforts to make audit-log data more comparable across vendors could make it possible to use system-generated data to measure the effect of these initiatives—without adding to burden in the process. Read More >>

IN THE JOURNAL

MEDICARE

Dental, Vision, And Hearing Services: Access, Spending, And Coverage For Medicare Beneficiaries
By Amber Willink, Nicholas S. Reed, Bonnielin Swenor, Leah Leinbach, Eva H. DuGoff, and Karen Davis

Among Medicare beneficiaries, dental, vision, and hearing services could be characterized as high need, high cost, and low use. Amber Willink and coauthors analyzed beneficiary survey data and found that in 2016 only 21 percent of beneficiaries in traditional Medicare had purchased a stand-alone dental plan, whereas 62 percent of Medicare Advantage enrollees were in plans with a dental benefit. Among Medicare beneficiaries with coverage overall, out-of-pocket expenses still made up 70 percent of dental spending, 62 percent of vision spending, and 79 percent of hearing spending. Read More >>

PAYMENT

When Should Medicare Mandate Participation In Alternative Payment Models?
By Joshua M. Liao, Mark V. Pauly, and Amol S. Navathe

As alternative payment models (APMs) expand in scope, one critical question is whether they should engage providers on a voluntary or a mandatory basis. Joshua Liao and coauthors compare the benefits and drawbacks of mandatory and voluntary participation and argue that both modes are necessary for APMs to achieve the goal of improving value.
Read More >>

CONSIDERING HEALTH SPENDING

Out-Of-Network Primary Care Is Associated With Higher Per Beneficiary Spending In Medicare ACOs
By Sunny C. Lin, Phyllis L. Yan, Nicholas M. Moloci, Emily J. Lawton, Andrew M. Ryan, Julia Adler-Milstein, and John M. Hollingsworth

Despite expectations that Medicare accountable care organizations (ACOs) would curb health care spending, their effect has been modest. One possible explanation is that ACOs’ inability to prohibit out-of-network care limits their control over spending. To examine this possibility, Sunny Lin and coauthors looked at the association between out-of-network care and per beneficiary spending using national Medicare data for 2012–15. Read More >>

See our Considering Health Spending page for more on this series topic.

GRANTWATCH

Funders’ Support For Water And Sanitation Efforts
By Lee L. Prina

The February 2020 GrantWatch column highlights what foundations are doing in the areas of improving drinking water quality (which "has a major influence on public health," according to the Centers for Disease Control and Prevention), and sanitation. Efforts in other countries and in the US are highlighted. Some people forget that even in the United States, having "clean water is not always assured," the CDC says. Funders from the Bill & Melinda Gates Foundation to the Robert Wood Johnson Foundation to the Conrad N. Hilton Foundation and more have funded in these areas. In the Key Personnel Changes section of the column, read about what David Fukuzawa of the Kresge Foundation is planning. Read More >>

AFFORDABLE CARE ACT

Changes In Health Insurance Coverage, Access To Care, And Income-Based Disparities Among US Adults, 2011–17
By Kevin N. Griffith, David K. Jones, Jacob H. Bor, and Benjamin D. Sommers

The Affordable Care Act increased insurance coverage and access to care, according to numerous national studies. However, the administration of President Donald Trump implemented several policies that may have affected the act’s effectiveness. Kevin Griffith and coauthors used survey data for 2011–17 from the Behavioral Risk Factor Surveillance System to assess changes in access to care among nonelderly adults from before to after the change in administration in 2017. Read More >>

About Health Affairs

Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking content is also found through healthaffairs.org, Health Affairs Today, and Health Affairs Sunday Update.

Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.

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