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A Weekly Health Policy Round Up From Health Affairs
January 19, 2020
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THIS WEEK ON THE BLOGFOLLOWING THE ACA
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 >>
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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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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 humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.
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