The Connection
A roundup of recent Fund publications, charts, multimedia, and other timely content.
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October 14, 2024
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What’s at Stake for Health Care in the Election
The election, now less than a month away, will have profound implications for the future of health care in the U.S. Decisions made by the next administration and Congress will determine how many people have health insurance, who can afford their health care, and whether care is delivered equitably. On To the Point, the Commonwealth Fund’s Rachel Nuzum and Reginald D. Williams II compare the likely health care priorities of a Harris or Trump administration.
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Can Spending More on Primary Care Save Money?
The United States spends just 5 to 7 cents of every health care dollar on primary care. Many states are now launching initiatives to increase funding for primary care. But will these investments lower the total amount spent on health care? In an article for Health Affairs Forefront, the Commonwealth Fund’s Corinne Lewis and colleagues report that while higher primary care spending is linked to better quality and fewer hospitalizations, evidence of the impact on overall spending is limited.
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FEATURED CHART
Why Are Medicare Beneficiaries Using Rx Discounters?
An increasing number of private, for-profit companies are offering Medicare beneficiaries discounts on their prescription drugs through online promotions or in-store coupons. But beneficiaries can’t use these offers with Medicare Part D drug coverage. On To the Point, the Commonwealth Fund’s Faith Leonard and Gretchen Jacobson look at how many Medicare beneficiaries are using these drug discount companies and the reasons they give for using them. “Beneficiaries need a better understanding of the benefits and trade-offs of using the discount sites and how to lower their prescription drug costs now while protecting themselves in the future,” the authors write.
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QUIZ
Between 2014 and 2016, what percentage of Medicare Advantage enrollees appealed a prior authorization request that their plan denied?
- 1%
- 5%
- 10%
- 20%
Scroll down to see if you got it right.
Preventing Overdose Deaths Through Harm Reduction
Over the years, harm-reduction programs that seek to reduce the risk and stigma associated with drug use, like syringe-exchange programs, have emerged as a central strategy in reducing overdose deaths in the United States. These programs, which prioritize safety and education over abstinence, are making a difference, especially when led by community members, advocates, and local organizations, say the Commonwealth Fund’s Arnav Shah and Celli Horstman on To the Point. But despite their success, legal, regulatory, and political barriers are limiting their impact.
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Paying Providers to Address Health-Related Social Needs
The Affordable Care Act’s expansion of Medicaid eligibility to more Americans enabled states to begin tying information about social risks like food and housing insecurity to the medical records of some 18 million newly insured people. With vastly different levels of investment, both Massachusetts and Minnesota have made strides in bridging the health and social sectors to achieve better health outcomes at lower costs. In our latest feature story, Sarah Klein explores the approaches each state has taken and the impact they’ve had so far.
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Strategies for Boosting Childhood Vaccination Rates
Childhood vaccination rates dropped across the globe during the COVID-19 pandemic. But five countries successfully maintained high vaccination rates for certain diseases, and they offer lessons for nations that have fallen behind. In a Commonwealth Fund issue brief, Brown University’s Irene Papanicolas and colleagues explore how Australia, Germany, Singapore, the U.K., and the U.S. approached pandemic-related changes to vaccine policy and practice. The authors review differences in eligibility, administration, requirements, and disruptions across the five countries for three routine childhood vaccinations.
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Advancing Health Equity Through Disruptive Innovation
Inequities for people of color are embedded in the U.S. health system, shaping their health care journeys and often leading to outcomes worse than those experienced by white Americans. That’s where Dr. Chris Pernell, director of NAACP’s Center for Health Equity, comes in. “Sometimes you got to make those systems bend, and other times you got to disrupt those systems, innovate and invent, and create and design.” On The Dose podcast, host Joel Bervell talks to Dr. Pernell about her work on health equity, the systems that need to be disrupted, and the innovations needed to build a more inclusive health system.
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Addressing America’s Health System Failures
A recent Commonwealth Fund report found that the United States ranks last in overall health system performance among a group of 10 high-income countries. In a New England Journal of Medicine perspective published last week, David Blumenthal, M.D., and the Fund’s Evan Gumas and Arnav Shah reflect on its findings and how the U.S. should respond. “What is the future of a country that allows an untold number of its people to suffer and die unnecessarily because of a lack of access to basic health services, inadequate public health measures, and a tattered social safety net?” the authors ask, noting the critical need to address social factors like poverty and homelessness.
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Mental Health Support for Students and Clinicians
Evidence of a mental health crisis is everywhere — from the recent surgeon general advisory about social media’s effects on our youth to the pandemic’s documented impact on medical professionals. To whom does a college student turn for help so far from home? And who cares for the mental health of those caring for us? Enter Dr. Jessi Gold, a psychiatrist and the University of Tennessee’s first chief wellness officer, who aims to change the way student mental health is addressed on campus. On The Dose, Joel Bervell talks with Dr. Gold about the systemic changes needed to support mental wellness across our college campuses and the entire ecosystem of medical professionals.
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Employers Turn to Direct Primary Care to Improve Access
U.S. companies spend more than $1 trillion every year on health care for employees and their families. But even workers with generous health plans complain it’s tough to find an affordable primary care provider. Several large firms have tried to fix things themselves by offering low-cost, primary health care right in their offices. With support from the Commonwealth Fund, the Tradeoffs podcast recently examined one big bank’s plans to ensure its employees get convenient, regular checkups and other routine care.
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Reducing Health Care Bias in Hospitals
Dorothy Roberts, J.D., professor of law and sociology at the University of Pennsylvania, and author of Torn Apart: How the Child Welfare System Destroys Black Families — and How Abolition Can Build a Safer World, was named one of 22 MacArthur Fellows ([link removed] ) this month. In a previous issue of Transforming Care, Roberts described strategies hospitals could use to reduce bias against Black parents ([link removed] ) , who are twice as likely as white parents to be subject to child welfare investigations.
QUIZ: Answer
The answer is A: Only 1 percent of Medicare Advantage plan denials were appealed by enrollees between 2014 and 2016, according to the U.S. Department of Health and Human Services Office of the Inspector General. However, plans overturned 75 percent of the denials they reviewed, meaning they decided in favor of beneficiaries and agreed to provide coverage for the services requested.
Writing on To the Point, Janet Sutton of Acumen notes that from 2016 to 2022, the number of “level 2” appeals — those resulting from denials that withstood the initial plan review and were subsequently submitted for independent review — rose from 3.1 to 5.6 per 1,000 Medicare Advantage enrollees. Despite this increase, the proportion of overturned denials dropped by more than half ([link removed] ) . Sutton says additional efforts are needed to ensure beneficiaries are getting the care they need in a timely manner, and that plans are held accountable.
Affordable, quality health care. For everyone.
The Commonwealth Fund, 1 East 75th Street, New York, NY 10021
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