The Connection

A roundup of recent Fund publications, charts, multimedia, and other timely content.

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March 25, 2024

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Does Medicare Advantage Affect Delivery of Primary Care?

Are Medicare Advantage plans enabling primary care physicians to coordinate their patients’ treatment more efficiently, or are they adding requirements that make it more difficult to provide care? A new Commonwealth Fund study by Arnav Shah and Gretchen Jacobson identifies differences in care delivery and administrative burden between physicians treating predominantly Medicare Advantage patients and those treating mostly traditional Medicare patients. The findings tell a complex story, one with important implications for patient care, primary care practices, and Medicare policy.

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Automatic Enrollment Can Reduce Number of Uninsured

Even though people with low incomes can access free or low-cost health coverage, the number of uninsured Americans remains high. Urban Institute researchers say there is a pathway to coverage that could have a substantial impact on the uninsured rate: automatically enrolling people who qualify for no-cost coverage in either Medicaid or marketplace plans. In addition to ensuring coverage for millions who are currently uninsured, auto-enrollment could also reduce the burden of uncompensated care on providers and government by nearly one-third, a new Commonwealth Fund report finds.

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FEATURED CHART

Women Shoulder the Responsibility of Caregiving

Of the 53 million Americans who were caregivers to an adult or child with a disability in 2020, more than 60 percent were women. Around the world, as many as 81 percent are women, providing assistance with a range of daily activities, from meal preparation to bathing. On To the Point, researchers discuss a Commonwealth Fund survey of 10 high-income countries that shows the heavy caregiving burden that women carry. According to the 2023 survey, U.S. women who provided informal care or assistance to a family member were significantly more likely to experience high rates of stress, anxiety, and depression than men who provided care.

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South Korea Addresses Intimate Partner Violence

In the United States, nearly half of all women, over a quarter of men, and even higher shares of LGBTQI+ people experience intimate partner violence at some point in their lifetimes. Many struggle to obtain safe and comprehensive care in the aftermath. The latest International Insights looks at South Korea’s Sunflower Centers, a program for helping victims of intimate partner violence gain affordable access to integrated services. It’s a model that may hold valuable lessons for the U.S.

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Understanding the Impact of Dobbs

Health services research can play an important role in illuminating the broader health system implications of the U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization. Earlier this month, an AcademyHealth webinar sponsored by the Commonwealth Fund examined the changing landscape of reproductive health through a health services research lens. The discussion highlighted the critical need for stronger partnerships between the health services and reproductive health research communities. A recording of the webinar is available here ([link removed] ) .

Integrating Primary and Specialty Behavioral Health Care

Evidence shows that common behavioral health conditions can be treated effectively when integrated into primary care settings. But patients with more complex behavioral health needs or conditions typically turn to specialty behavioral health providers, who may not coordinate with other health care settings. On To the Point, the Commonwealth Fund’s Rachel Nuzum and Nathaniel Counts discuss how the flexibility afforded by alternative payment models like value-based payment can promote integration of specialty behavioral health and physical health care — and improve patients’ overall health.

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What to Do About the Direct Care Worker Shortage?

The U.S. faces an acute shortage of nursing assistants, home health aides, and other direct care workers, and it’s threatening the ability of millions of aging Americans, as well as younger people with disabilities, to remain in their homes and communities. In a Commonwealth Fund issue brief, Barbara Lyons and Molly O’Malley Watts report on interviews with state officials, provider organizations, community partners, and aging and disability experts about the progress states have made in bolstering the direct care workforce ([link removed] ) . In a related To the Point post, Lyons and Jane Andrews explore ways to strengthen recruitment and retention ([link removed] ) , drawing on findings from focus groups with direct care workers.

Placing a Higher Value on Direct Care Workers

Last month, the U.S. Department of Health and Human Services announced its Administration for Community Living program will be offering technical assistance to states ([link removed] ) working to improve the recruitment and retention of the direct care workforce. Transforming Care previously described how employers and states are experimenting with ways to recognize and reward direct care workers ([link removed] ) , including through advanced training and pathways to promotion.

Supporting Spanish-Speaking Patients at COVID’s Start

“Our community was being decimated by COVID, and when patients with limited English proficiency were admitted, not only did they have to fight COVID, they had to fight to communicate, to understand their caregivers, and to be understood. Action was needed.” This is how Commonwealth Fund President Joseph Betancourt, M.D., remembers March 2020, when he was Massachusetts General Hospital’s vice president and chief equity and inclusion officer. In an excerpt from his contribution to the collection, Voices from the Front Lines: The Pandemic and the Humanities, Betancourt recalls the quick action he and his colleagues took to ensure that members of Boston’s Spanish-speaking communities — who at that time were literally fighting for their lives — would be understood.

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Health Systems Can Motivate Clinicians on Climate Action

Many U.S. hospitals and health care systems have committed to doing their part to reduce greenhouse gas emissions and mitigate climate change impacts. But how will they act on these pledges? Highlighting findings from the Commonwealth Fund’s 2023 Climate and Health Care Workforce Survey, Arnav Shah and Lovisa Gustafsson report that many clinicians believe their employers could do a better job of explaining the link between individual action and organizational impact — including how sustainability improvements can save clinicians time and money.

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Healthy Transitions from Incarceration to Community

Every year, hundreds of thousands of Americans return home from prison and jail. Because they lose insurance coverage during incarceration, many must navigate a fragmented patchwork of health care services on their own. This month, Congress passed legislation that includes Medicaid policy changes designed to improve care transitions and access to support for this population. On To the Point, experts from Waxman Strategies and the Health and Reentry Project explain how these changes can help by suspending, rather than terminating, Medicaid enrollment for incarcerated people; using state grants to build operational capacity; and making connections to community providers.

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Affordable, quality health care. For everyone.

The Commonwealth Fund, 1 East 75th Street, New York, NY 10021

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