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A Weekly Health Policy Round Up From Health Affairs            

**November 17, 2019**

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THIS WEEK ON THE BLOG

FOLLOWING THE ACA

****

Oral Arguments Held Over AHP Rule

By Katie Keith (11/15/19)

On November 14, 2019, a three-judge panel of the Court of Appeals for
the District of Columbia Circuit-Judges David S. Tatel, Gregory G.
Katsas, and Karen LeCraft Henderson-heard oral argument in a dispute
over the validity of a regulation to expand access to association health
plans. Read More >>

CMS Releases Week Two Enrollment Snapshot

By Katie Keith (11/14/19)

So far, total plan selections for 2020 are down from the nearly 1.2
million consumers who selected a plan last year between November 1 and
November 10 in the 39 states that used HealthCare.gov. Read More >>

ACA Round-Up: First Enrollment Report, SBC Updates, And More

By Katie Keith (11/12/19)

This post covers the first weekly enrollment report, updates to the
Summary of Benefits and Coverage (SBC), a new enforcement safe harbor
for direct enrollment (DE) entities on quality rating requirements, an
extension of relief for dual enrollees in Medicare and marketplace
coverage, and data submission requirements for the risk adjustment
program for 2019.
Read More >>

CONSIDERING HEALTH SPENDING

To Succeed, MIPS Value Pathways Need More Episodic Cost Measures

By Joshua M. Liao, Sophie C. Miller, and Amol S. Navathe (11/14/19)

In proposing new Merit-based Incentive Payment System value pathways,
CMS intends to increase the program's salience to clinicians and
increase alignment among different MIPS domains. Read More >>

SYSTEMS OF CARE

Bernard Tyson Is Gone Way Too Soon

By George C. Halvorson (11/14/19)

We need to make sure that people understand what Bernard did and who he
was, because we need role models for our country and our people at this
point in our history. Bernard provided that role model with joy, grace,
integrity, and skill, and with core levels of truth, commitment, and
positive energy every day. Read More >>

PUBLIC HEALTH

Using The County Health Rankings To Assess County Performance At A
National Scale

By Jessica Athens (11/14/19)

Is there a way to see how the counties in one state are faring on health
outcomes measures, compared to counties nationwide? Yes, says a policy
and research officer at the New York State Health Foundation, who
describes a September 2019 report it issued on this subject. Read More
>>

MEDICARE

Treat ACOs And MA Plans Equally? By All Means

By Joseph R. Antos and James C. Capretta (11/13/19)

Medicare should establish policies to ensure that accountable care
organizations and Medicare Advantage plans are treated fairly, but such
policies must account for the substantial differences in the way those
alternatives operate. Read More >>

HIV/AIDS

Ending An Epidemic Requires Multiple Interventions: Considerations For
Developing And Harmonizing HIV Preventive Recommendations

By Richard Hughes IV, Chris Sloan, Alisa Vidulich, Chloé Chepigin, and
Manny Aviña (11/13/19)

The specter of overlapping or competing Advisory Committee on
Immunization Practices and US Preventive Services Task Force
recommendations that could undermine efforts to reduce HIV transmissions
underscores the need for a collaborative recommendation development
process between the recommending bodies. Read More >>

HEALTH INFORMATION TECHNOLOGY

Time For A Health Information Agency

By Julie Barnes and Mattie Quinn (11/12/19)

It's time to step into this brave new world, one that we've always
hoped for in health care: where patients are empowered, health data are
in real time, and the whole system no longer feels like a handful of
people making decisions behind a curtain. Read More >>

SYSTEMS OF CARE

Stop Blaming The Victim: The Case For Systemic Health System
Transparency

By Niall Brennan and Katie Martin (11/12/19)

Decision makers and policy makers-federal, state, local, and private
sector-need more and better information to consider and implement
changes that can alter the trajectory of health care spending. Greater
transparency, by which we mean a comprehensive view of where and how
health care dollars flow and what is driving them, is a key tool in
enabling those changes. Read More >>

ELDER CARE

Mobilizing Public Health To Support Elders' Longevity And Thriving

By John Auerbach and Joanne Lynn (11/15/19)

The situation for frail elders, families, and governments will be dire
within a dozen years if leadership and resources do not shift to meet
population needs. Read More >>

MEDICAID

Improper Medicaid Enrollment Following ACA Expansion

By Aaron Yelowitz (11/15/19)

The evidence-whether broad survey data from the Census Bureau's ACS
or highly detailed audits from the OIG-suggests serious problems with
program integrity related to the ACA's Medicaid expansion. Read More
>>

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IN THE JOURNAL

AHEAD OF PRINT: EYE ON HEALTH REFORM

Health Reform On The Campaign Trail

By Katie Keith

In this primer, Katie Keith summarizes the range of Democratic
candidates' proposals, from improving the ACA to Medicare for All,
noting the different plans' costs, impacts, and trade-offs. She
observes that some candidates have shifted their positions, which may
"be in reaction to the public debate, which has thus far focused on
simple answers to complex questions such as whether each candidate
supports banning private health insurance or not, how each will pay for
their plan, and whether coverage options should be extended to
undocumented people." Read More >>

AFFORDABLE CARE ACT

As Insurers Exit Affordable Care Act Marketplaces, So Do Consumers

By Daniel Crespin and Thomas DeLeire

Much has been written about the stability of the ACA Marketplaces.
Daniel Crespin and Thomas DeLeire analyze the relationship between
insurer exits from the Marketplaces and consumer decisions to reenroll
in policy years 2015-18. Read More >>

California's New Gold Rush: Marketplace Enrollees Switch To Gold-Tier
Plans In Response To Insurance Premium Changes

By Petra W. Rasmussen, Thomas Rice, and Gerald F. Kominski

"Silver loading" occurred when the Trump administration discontinued
cost-sharing reduction payments to health plans, and some states
permitted insurers to place the entire cost of these subsidies on
silver-tier plans. Petra Rasmussen and coauthors examine Marketplace
enrollees' behavior in California between the 2014-15 and 2017-18
open enrollment periods in response to silver loading. Read More >>

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ENTRY POINT: AGING & HEALTH

Age-Friendly Care At The Emergency Department

By Michele Cohen Marill

Mount Sinai Hospital in New York City is at the forefront of an
innovative approach to geriatric emergency care.Read More >>

LEADING TO HEALTH: DETERMINANTS OF HEALTH

Integrating Pediatric Care And Taking On Risk To Improve Health

By Rebecca Gale

In Delaware, Nemours Children's Health System wants to get paid for
keeping children healthy. Read More >>

PATIENT-CENTERED CARE

Frequent Emergency Department Users: Focusing Solely On Medical
Utilization Misses The Whole Person

By Hemal K. Kanzaria, Matthew Niedzwiecki, Caroline L. Cawley, Carol
Chapman, Sarah H. Sabbagh, Emily Riggs, Alice Hm Chen, Maria X.
Martinez, and Maria C. Raven

To better understand the wide-ranging problems of frequent and
superfrequent ED users (defined as four or more and 18 or more ED visits
per year respectively), Hemal Kanzaria and coauthors examined Medicaid
claims data in the years 2013-15 linked to records from San Francisco
County's Coordinated Care Management System (CCMS). Read More >>

Read the November 2019 Table of Contents

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