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The Commonwealth Fund Connection

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




September 19, 2022

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What Does Behavioral Health Look Like in the U.S.?
Behavioral health conditions affect tens of millions of Americans, impacting their physical and emotional health as well as their social and economic well-being. Yet many people face serious barriers to treatment, including high costs, a shortage of providers, and cultural factors. In our new explainer, we discuss the prevalence of behavioral health problems in the U.S., how treatment is provided and paid for, why equitable access to care is an issue for many, and what we can do about it.

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Integrating Behavioral Health to Make Access More Equitable
Although behavioral health and physical health are profoundly linked, behavioral health care in the U.S. is usually delivered separately from primary care — and the two are often poorly coordinated. There is also a severe shortage of behavioral health providers. A new explainer shows why integrating behavioral health care with primary care can help promote equitable access to behavioral health services.

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Advancing Health Equity: What the U.S. Can Learn from Other Countries
Countries around the world are experimenting with ways to reduce disparities in health and distribute health care resources more equitably. On To the Point, former Commonwealth Fund Harkness Fellow Nason Maani and Sandro Galea describe promising, evidence-based approaches from eight countries that could help reduce health inequities in the U.S.

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How Payment Reform Can Make Primary Care More Equitable
Especially given its importance to achieving better, more equitable health outcomes, primary care in the United States is both undervalued and underresourced. On To the Point, experts from the Primary Care Collaborative and the Commonwealth Fund argue that hybrid payment models that incorporate capitated and fee-for-service payments could strengthen primary care and increase health equity.

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Reducing Diabetes Disparities Through Health Insurance Reforms
Affordability is a serious barrier to diabetes care, especially for Black and Hispanic people, who are hospitalized at higher rates because of complications from the disease. Georgetown University’s Christine Monahan and Jalisa Clark look at how states and state-based marketplaces are trying to mitigate the disproportionate impact of diabetes on communities of color by reducing treatment costs and increasing quality of care.

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Raising Medical School Enrollment for Black and Brown Students
A study in Annals of Internal Medicine found
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state affirmative action bans were associated with significant reductions in the percentage of students in U.S. public medical schools from underrepresented racial and ethnic groups. A 2021 Commonwealth Fund report looked at strategies medical schools have used to
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increase enrollment of students from these communities , including detecting unconscious bias among admission committee members.

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Improving Health Outcomes for People Leaving Jail or Prison
Several states are proposing to use Medicaid waivers to treat the chronic health conditions, substance use disorders, and mental health issues that are common among people who are incarcerated. Manatt Health’s Cindy Mann and colleagues explain that federal law currently only allows Medicaid coverage for hospital care for people in jail or prison. But some states are seeking to provide people with proactive care management and treatment prior to their release — and to connect them with ongoing care afterwards.

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The Link Between Health Care and Criminal Justice Reform
Because federal law prohibits Medicaid from covering most health care services for people in prisons and jails, these individuals are at risk of returning to their communities in poor health or with unmanaged chronic conditions. Health policy expert John Sawyer and colleagues describe efforts to enable people to return to their communities “healthy and whole.” They describe reentry care models featuring enhanced primary care and connections to behavioral health, trauma-informed approaches, and integrated social and health supports.

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When Federal Laws Requiring Emergency Care Clash with State Abortion Laws
Following the Supreme Court’s Dobbs decision, about half of states are implementing laws to outlaw or limit abortion. But as Timothy Jost explains on To the Point, health professionals in those states now face a profound dilemma: what to do when a patient’s health calls for an emergency abortion that is prohibited by state law? He walks us through two recent lawsuits that reached different conclusions on how the Emergency Medical Treatment and Labor Act interacts with state abortion laws and considers what will happen in the future.

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Next Steps in Making Health Coverage More Affordable
The Inflation Reduction Act aims to make health insurance more affordable for Americans who are eligible for coverage through the Affordable Care Act’s marketplaces. The Urban Institute’s John Holahan and Michael Simpson examine five policies that could build on the new reforms, including offering marketplace coverage to low-income residents of states that haven’t expanded Medicaid as well as to more people who can’t afford their employer’s health plan.

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What the Inflation Reduction Act Really Means for Health Care
Among other things, the Inflation Reduction Act is being hailed as a potential breakthrough in making health care more affordable. But what does this landmark legislation really mean for Americans — now and in the future? To open the new season of The Dose podcast, host Shanoor Seervai interviews Stacie Dusetzina of Vanderbilt University, who breaks down the key health provisions of the new law, from drug price negotiation in Medicare to the redesign of Part D coverage.

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Stay on Top of Your State’s Health Care Policies and Trends
The Commonwealth Fund’s refreshed State Health Data Center continues to serve as an all-in-one resource for understanding health care in every state. Explore today’s most accessible and up-to-date health care database to see how your state is doing on important issues ranging from health insurance and medical costs to health outcomes and health equity. State demographics, such as total population, median household income, and racial breakdowns, coupled with easily digestible data visualizations, create a personalized experience that provides a clearer picture of thehow state policies impact health.

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Texas Judge Invalidates ACA Requirement for Free Preventive Care
Battles over the Affordable Care Act continue. This month, a Texas federal court judge held that part of the law’s requirement that health plans cover preventive services without copayments, coinsurance, or deductibles was unconstitutional. Judge Reed O’Connor also ruled that one of the companies that brought the suit could not be required to cover PrEP, a preventive treatment for HIV and AIDS, because of its religious objections. Health law expert Timothy Jost takes us through the ruling and what it may mean for the ACA’s future.

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The 340B Drug Pricing Program: What It Is and Why It’s Controversial
The federal 340B Drug Pricing Program was created to allow safety-net hospitals and clinics to purchase outpatient prescription drugs at significant discounts so they could stretch their resources to serve more financially vulnerable patients. But as 340B continues its rapid expansion of the last two decades, the efficacy of the program in reducing patient costs has come into question, and pharmaceutical companies have stepped up their efforts to rein in the program. In a new explainer, we examine the reasons behind the program’s growth, the claims and counterclaims made by drugmakers and health care providers, and how federal regulators and Congress are responding.

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How to Better Support America’s Direct Care Workers
During the pandemic, people began paying attention to the essential workers who can’t work from home. Among them are direct care workers — the aides who provide support to older adults and people with chronic health conditions in their homes, the personal care attendants who assist people with developmental disabilities, and the certified nursing assistants who work in skilled nursing facilities. In a new interview with Transforming Care, Kezia Scales, senior director of policy research at the nonprofit PHI, discusses the opportunities for health and long-term care organizations to better support and build the direct care workforce.

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Introducing the Incoming Harkness Fellows
The Fund is pleased to welcome the new class of Commonwealth Fund Harkness Fellows in Health Care Policy and Practice. This year’s fellows are rising leaders from Australia, France, the Netherlands, New Zealand, Norway, and the United Kingdom who have come to the U.S. to gain an in-depth understanding of the U.S. health care system and policy landscape, engage in a series of leadership development activities, and build a robust network for cross-national exchange and collaboration.

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