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A Weekly Health Policy Round-Up From Health Affairs            

**November 15, 2020**

THIS WEEK ON THE BLOG

FOLLOWING THE ACA
Supreme Court Arguments: Even If Mandate Falls, Rest Of Affordable Care
Act Looks Likely To Be Upheld

By Katie Keith (11/11/20)

On November 10 the Supreme Court heard oral argument over the
constitutionality of the individual mandate and the fate of the entire
ACA. The Justices' comments and questions suggest that the rest of the
ACA will be upheld even if the mandate is found unconstitutional. Read
More >>

COVID-19

What The New Administration Must Do On Day One To Tackle COVID-19

By Terry A. Adirim (11/12/20)

To turn the tide on the COVID-19 pandemic, the new administration will
have to do a number of things beginning on January 20, 2021. First and
foremost, a comprehensive response strategy and detailed plan must be
communicated across the federal government, among states and local
communities, and to the public. Read More >>

COSTS & SPENDING

Understanding The Latest ACO "Savings": Curb Your Enthusiasm And
Sharpen Your Pencils-Part 1

By J. Michael McWilliams and Alice Chen (11/12/20)

Did the Medicare Shared Savings Program (MSSP) save Medicare $1.2
billion in 2019? No-not even close. Might the true net savings be
close to zero? Quite possibly. Is the MSSP headed in the right
direction? No. Can reforming MSSP design make the program more
successful? Yes. Read More >>

Understanding The Latest ACO "Savings": Curb Your Enthusiasm And
Sharpen Your Pencils-Part 2

By J. Michael McWilliams and Alice Chen  (11/13/20)

At this stage of Medicare payment reform, progress is not served by
applauding illusory savings or overselling simple solutions such as
downside risk. Payment reform in Medicare needs reform. Conversations
need to happen (and continue). Slapdash analysis and slogans should not
be tolerated. Instead, sound evidence and theory should inform vision
and set a course. Read More >>

Evaluation Of Medicare Alternative Payment Models: What The Data Show

By Clifton Gaus and David Pittman (11/12/20)

We believe the data in Medicare are clear: The success of total cost of
care, population-health models such as Medicare accountable care
organizations far outpaces the performance of narrowly focused
alternative payment models. Read More >>

How ACOs In Rural And Underserved Areas Responded To Medicare's ACO
Investment Model

By Lauren M. Scarpati, J. Michael McWilliams, Heather McPheron, Betty T.
Fout, and Matthew J. Trombley (11/10/20)

To help establish accountable care organizations (ACOs) in more areas of
the country, the Centers for Medicare and Medicaid Services developed
the ACO Investment Model (AIM) to provide participating ACOs with
up-front and ongoing monthly payments. Our evaluation thus highlights
that, in spite of a lack of geographic proximity, AIM ACOs overall were
able to significantly reduce costs. Read More >>

MARKETS

Will We Ever Get Off This Escalator?

By William Kramer (11/9/20)

The most recent Kaiser Family Foundation Employer Health Benefits Survey
indicates yet another year of relentlessly rising premiums, reminding us
that we cannot expect to achieve access to affordable coverage and care
if we don't deal with the cost issue. Read More >>

GOVERNMENT PROGRAMS AND POLICIES
What The 2020 Election Means For Prescription Drug Policy

By Rachel Sachs (11/13/20)

Despite the Trump administration's failure to implement its most
ambitious drug pricing policy goals, the rhetoric on the subject from a
Republican president may create space for executive policy making in
President-elect Biden's administration. The president-elect will also
have the difficult task of restoring the public's trust in the
government's agencies with deep scientific and public health
expertise, particularly the FDA and the CDC. Read More >>

HEALTH INFORMATION TECHNOLOGY

The Case For Mathematical Optimization In Health Care: Building A Strong
Foundation For Artificial Intelligence

By Alekhya Reddy and David Scheinker (11/13/20)

Enthusiasm for the potential impact of artificial intelligence (AI) on
hospital operations is often based on its impact in other industries.
However, non-health care companies invest in AI after having digitized
and optimized their operations with a variety of older mathematical
methods. In contrast, hospitals may invest in AI while still scheduling
patient appointments using fax machines and allocating resources based
largely on anecdotal experience. Read More >>

AGE-FRIENDLY HEALTH

Strengthening Family Caregiving Policies And Programs Through State
Collaboration

By Courtney Roman, Rani Snyder, and Erica Brown (11/12/20)

Family caregiving provides a substantial savings to the health care
system. Such caregiving is normally stressful but is even more so during
a pandemic. Helping States Support Families Caring for an Aging America,
an initiative that received funding from four foundations in its Phase
I, helped six states to advance policy and program changes for family
caregivers. Lessons learned included the importance of collecting and
exchanging robust data about caregivers' role and value. Read More >>

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Hate-Motivated Behavior: Impacts, Risk Factors, And Interventions

By Robert J. Cramer, Richard C. Fording, Phyllis Gerstenfeld, Andre
Kehn, Jason Marsden, Cynthia Deitle, Angela King, Shelley Smart, and
Matt R. Nobles

A newhealth policy brief

from **Health Affairs** with support
from the Robert Wood Johnson Foundation explores
the causes of and approaches to preventing hate-motivated behavior, a
public health threat with structural, interpersonal, and individual
repercussions.

This brief joins

**Health Affairs'** ongoing series of policy briefs on social
determinants of health.

IN THE JOURNAL

ORAL HEALTH

Changes In Coverage And Access To Dental Care Five Years After ACA
Medicaid Expansion

By Hawazin W. Elani, Benjamin D. Sommers, and Ichiro Kawachi

Oral health is an area of significant unmet need, particularly among
people with low incomes. Hawazin Elani and coauthors, analyzing how the
Affordable Care Act affected dental coverage for adults with incomes
below 125 percent of poverty, find that it increased rates of dental
coverage by almost 20 percentage points among this population in states
that expanded Medicaid and that include dental care as a benefit. Read
More >>

CONSIDERING HEALTH SPENDING

Getting The Price Right: How Some Countries Control Spending In A
Fee-For-Service System

By Michael K. Gusmano, Miriam Laugesen, Victor G. Rodwin, and Lawrence
D. Brown

Fee-for-service payment is routinely blamed for excess US health
spending. Michael Gusmano and coauthors analyze how physician fees are
set in France, Germany, and Japan-countries that pay physicians
fee-for-service. Although their approaches differ, all three countries
set fees through centralized negotiation within the context of spending
constraints. Read More >>

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New podcast!

Health Affairs Editor-in-Chief Alan Weil interviews Michael K. Gusmano,
lead author of today's featured journal article.

What can the US learn from three countries-France, Germany, and
Japan-that appear to achieve economic sustainability in a
fee-for-service system? Is policy importation even possible?

Listen here.

AGE-FRIENDLY HEALTH

Cognitive Assessment At Medicare's Annual Wellness Visit In
Fee-For-Service And Medicare Advantage Plans

By Mireille Jacobson, Johanna Thunell, and Julie Zissimopoulos

The Medicare annual wellness visit-a preventive care visit free to
Medicare beneficiaries enrolled in Part B-requires detection of
cognitive impairment. Mireille Jacobson and coauthors surveyed an
internet panel of adults ages sixty-five and older who were enrolled in
fee-for-service Medicare or Medicare Advantage to measure the use of
that benefit and the receipt of structured cognitive assessment by 2019.
Read More >>

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OPIOID USE DISORDER

Confronting An Opioid Crisis And Promoting Health From All Angles

By Charlotte Huff

In taking on the scourge of opioid use disorder, Kentucky researchers
have pursued a wide-ranging collection of interventions. Read More >>

ANNOUNCEMENT-AGE-FRIENDLY HEALTH

**Health Affairs** is beginning a new series, Age-Friendly Health
,
that will present articles to inform policies on the local, state, and
federal levels aimed at improving the care of older adults.

The series runs through June 30, 2022. It will build upon the Aging and
Health series
,
which began in 2015, but will also cover new issues including the impact
of the COVID-19 pandemic on older adults and caregivers and take a
closer look at health care equity and disparities.

We are interested in work that spans the full range of care settings,
including primary care and specialty practices, hospitals, nursing
homes, other long-term care settings, and patients' homes. We also
welcome papers on related dimensions that affect care, access, and
affordability, such as financing models, coverage, technology, size and
composition of the workforce, and social determinants of health.

We are grateful to The John A. Hartford Foundation for providing support
for our ongoing coverage of these topics.

For more information, see our announcement page
.

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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
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health care workers to save lives across the globe. Project HOPE has
published Health Affairs since 1981.

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