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A Weekly Health Policy Round Up From Health Affairs            

**January 19, 2020**

THIS WEEK ON THE BLOG

FOLLOWING THE ACA
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Federal Circuit Hears Oral Argument Over Unpaid CSRs

By Katie Keith (1/15/20)

On January 9, 2020, a three-judge panel of the Court of Appeals for the
Federal Circuit held oral argument in four consolidated cases over
whether insurers are entitled to unpaid cost-sharing reduction payments.
Read More >>

ACA Round-Up: Enrollment Numbers, New 1332 Guidance, QHP Enrollee Survey
FAQ
By Katie Keith (1/15/20)

In the first two weeks of January 2020, the Centers for Medicare and
Medicaid Services has released updated enrollment numbers for
HealthCare.gov, updated resources on pass-through funding for Section
1332 waivers, and a new frequently asked question on reporting
requirements for the 2020 qualified health plan (QHP) enrollee
experience survey.
Read More >>

HEALTH REFORM

Five Health Care Trends For 2020

By Susan DeVore (1/13/20)

There are some clear trends on the horizon that could fundamentally
alter the health care narrative well into the next decade. Read More >>

HEALTH EQUITY

Implicit Bias Curricula In Medical School: Student And Faculty
Perspectives

By Swapna Reddy, Stephanie Starr, Sharonne Hayes, Joyce Balls-Berry,
Mary Saxon, Matthew Speer, Jessica Todsen, Johanny Lopez Dominguez, and
Natalia Wilson (1/15/20)

Including implicit bias curricula in medical education is a crucial
proactive opportunity in developing future physicians who can contribute
to a more equitable health care system. Read More >>

Beyond Racial Bias: Rethinking Risk Stratification In Health Care

By Leonard W. D'Avolio (1/15/20)

A recent study by Ziad Obermeyer and colleagues in Science identified a
racial bias in a risk stratification algorithm that is used to
prioritize patients for care management. This study and the concerns it
raised offer an opportunity to carefully consider unintended
consequences of the prevalent approaches of stratifying risk to find a
new way forward. Read More >>

It's Time To Address The Role Of Implicit Bias Within Health Care
Delivery

By Shantanu Agrawal and Adaeze Enekwechi (1/15/20)

We propose a few solutions that can help to drive continued gains in
health equity and address factors internal and external to delivery
systems. We envision two main leverage points to address equity: the
health care workforce and the use of data and performance measurement
coupled with payment policies. Read More >>

ACCESS TO CARE

Cutting Medicaid Non-Emergency Medical Transportation Will Harm
Community-Level Public Transportation

By Michael Adelberg, Scott Bogren, and Alexandra King (1/14/20)

The budding interest in social determinants of health sharpens the focus
on transportation as an asset that impacts both the health of
individuals and population health. Read More >>

Why Aren't More Patients Electronically Accessing Their Medical
Records (Yet)?

By Christine Bechtel, Lygeia Ricciardi, Dave deBronkart, Casey Quinlan,
and Donna Cryer (1/13/20)

It's time to make a dramatic shift to a world in which patient data is
no longer a closely held business asset, but a private (for use by the
individual!) and public good. Read More >>

PHYSICIANS

Taking Back Control-Can Quality Improvement Enhance The Physician
Experience?

By Lisa S. Rotenstein and Amanda K. Johnson (1/14/20)

The solutions to alleviating burnout among physicians will ultimately
involve interventions focused on both individuals and organizations.
Among the many strategies being tested, giving physicians back control
over their environments through provision of improvement skills and
opportunities to engage in improvement can not only be uniquely
empowering but also enhance our systems of care. Read More >>

PRIVATE HEALTH INSURANCE

Nudging Into Insurance Coverage: Lessons From 401(k) Auto-Enrollment

By Nathan Hodson (1/16/20)

Christen Linke Young's retroactive model offers new hope for
auto-enrollment into health insurance, but behaviorally informed
adjustments will be required to use the power of auto-enrollment for
good. Read More >>

PAYMENT

Administration Fails To Assess Impact Of Major Changes Proposed For
State Medicaid Financing and Supplemental Provider Payments

By Edwin Park (1/16/20)

On November 18, the Centers for Medicare and Medicaid Services (CMS)
issued a proposed "Fiscal Accountability" rule, which could
significantly change how states finance their share of the cost of
Medicaid programs and how states provide supplemental payments to
hospitals, nursing homes, physicians, and other providers. Despite its
likely broad, harmful impact, CMS acknowledges that the fiscal effects
of the proposed rule on state Medicaid programs are largely "unknown."
Read More >>

COMMUNICATION

You've Got To Hear This: Funding A New Health Policy Podcast

By Steven Birenbaum and Jordan Reese (1/15/20)

The podcasting world is bursting with content, and there are an
increasing number of health policy podcasts to choose from. Health
philanthropy has been getting involved in this medium, too. For example,
two foundations are supporting a new podcast at the intersection of
economics and health policy. Staffers at the two funders explain why
they believe in the potential of podcasts and how they plan to build an
audience. Read More >>

HOUSING

Medicaid Doesn't Pay For Housing. Here's What It Can Do To Help Meet
Enrollees' Social Needs

By Hannah Katch and Peggy Bailey (1/17/20)

The health care system can't significantly improve health outcomes,
widen access, and control costs if policy makers don't prioritize
funding for the programs that address the social determinants of health.
Read More >>

IN THE JOURNAL

EYE ON HEALTH REFORM

Texas Ruling Brings More ACA Uncertainty

By Katie Keith

Katie Keith reviews the history of Texas v. United States, a case
concerning the constitutionality of the Affordable Care Act (ACA). The
recent Fifth Circuit Court of Appeals ruling remands the case back to
the district court for further consideration. Keith notes that this
decision could delay the resolution of the case, particularly if the
Supreme Court declines to hear an appeal made by twenty-one Democratic
attorneys general-which could lead to years of future litigation.

The Supreme Court is also considering another ACA lawsuit over unmade
risk-corridor payments arguably owed to insurance companies by the
Department of Health and Human Services. Keith observes that while the
justices peppered both sides with challenging questions during the oral
arguments, they appeared more sympathetic to the insurers' contention
that the government was obligated to make full payments regardless of
mitigating circumstances. Read More >>

THE PRACTICE OF MEDICINE

Medical Professionalism In An Organizational Age: Challenges And
Opportunities

By David J. Rothman, David Blumenthal, and George E. Thibault

The structure of medical practice is undergoing an extraordinary
transformation. The percentage of physicians salaried and employed by
hospitals and health care groups has increased dramatically. Growing
numbers of patients are using health information technologies to manage
their health care. David Rothman and coauthors aim to start a dialogue
on how these changes may affect the key responsibilities of medical
professionalism: putting patient interests first, maintaining and
enhancing physicians' medical competence, and sustaining trust in the
doctor-patient relationship. Read More >>

The Practice Of Medicine
series is
supported by the Physicians Foundation.

BEHAVIORAL HEALTH CARE

Trends In Opioid Prescribing And Self-Reported Pain Among US Adults

By Mark Olfson, Shuai Wang, Melanie M. Wall, and Carlos Blanco

Mark Olfson and coauthors evaluated data from the Agency for Healthcare
Research and Quality about opioid prescribing for the years 2014-16.
Among the key findings: In 2016, 24.91 million adults were prescribed
Schedule II or III opioids-a significant decrease from 2014, when
30.87 million adults were prescribed them. According to the authors,
this decrease occurred among both those experiencing severe or moderate
pain and patients with lesser pain. Read More >>

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MEDICARE

The Impact Of Bundled Payment On Health Care Spending, Utilization, And
Quality: A Systematic Review

By Rajender Agarwal, Joshua M. Liao, Ashutosh Gupta, and Amol S. Navathe

Bundled payments for discrete services are designed to create incentives
for efficient resource allocation by providers. Rajender Agarwal and
coauthors conducted the first systematic review of three programs
administered by the Centers for Medicare and Medicaid Services starting
in 2009: the Acute Care Episode Demonstration, the Bundled Payments for
Care Improvement initiative, and the Comprehensive Care for Joint
Replacement model. Read More >>

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NARRATIVE MATTERS:
PATIENT-CENTERED CARE

To Treat My Patient, I Had To Understand Her Trauma

By Eve Rittenberg

A patient who is a survivor of abuse benefits from a health care
approach that acknowledges her past trauma.
Read More >>

Listen to the podcast here
.

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