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The Connection

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




February 10, 2023

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Spending More Doesn’t Always Yield Better Health
The United States spends two to four times more on health care than most other high-income countries, yet Americans die younger and are far less healthy than residents of those nations, a new Commonwealth Fund study finds. In comparing health care spending and outcomes, health status, and health care usage in 13 countries, the researchers find that the U.S. has the highest rates of infant and maternal deaths, avoidable deaths, and deaths by assault, which includes gun violence.

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Filling Behavioral Health Gaps in Rural Communities
In 2016, Dayton General Hospital in rural southwest Washington began accepting referrals to fill unused beds with patients discharged from urban hospitals, particularly those with complex health needs who can be hard to place. Sarah Klein and Martha Hostetter report on how this change brought much-needed behavioral health services to the community, where a third of primary care patients screened positive for depression.

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A Comprehensive Response to the Opioid Crisis

Legal settlements with opioid manufacturers, distributors, and pharmacies accused of fueling the opioid crisis are expected to bring much-needed funding to states and counties that are seeing a record number of overdoses. The latest Transforming Care explores what a comprehensive approach to addressing opioid use disorder might look like. We highlight promising models from around the country that are helping communities reduce overdoses and engage people in their treatment.

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A National Strategy for Youth Behavioral Health Services

During the COVID-19 pandemic, the number of young people diagnosed with behavioral health problems exploded. At the same time, the size of the behavioral health workforce — particularly providers who work with young people — has been in steady decline. Laura Conrad of the Technical Assistance Collaborative discusses the need for coordinated action, calling for a 10-year national youth mental health workforce strategy that addresses pay equity, loan forgiveness, professional capacity-building, interstate licensure simplification, and diversity.

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New Zealand Is Confronting Its Youth Mental Health Crisis Head-On

While problems like COVID-19, poverty, and housing insecurity affect young people around the globe, the mental health supports available to them vary considerably among countries. As the Commonwealth Fund’s Evan Gumas reports in our International Insights newsletter, New Zealand has one of the highest youth suicide rates in the developed world, but the nation is also leading the way in prioritizing investment in mental health services for this particularly vulnerable group.

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Mental Health Concerns of Youth Changed During the Pandemic

Researchers at Boston Children’s Hospital found that visits to pediatric care providers for eating disorders and mood disorders
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rose during the COVID-19 pandemic, while visits for alcohol and substance use disorder fell. In a recent Transforming Care, Commonwealth Fund researchers described
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care models tailored to the unique needs of young people, including clinics and youth centers that offer a range of clinical and social supports.

Can Georgia “Expand” Medicaid by Drastically Reducing Eligibility?

A federal court ruling will allow Georgia to proceed with a Trump-era Medicaid waiver that seeks to exclude hundreds of thousands of low-income adults from health coverage they would otherwise qualify for under the Affordable Care Act. On To the Point, health law expert Sara Rosenbaum notes that the ruling forces the Biden administration to grant a section 1115 waiver that would condition enrollment on meeting work requirements, cap eligibility at 100 percent of the federal poverty level, and require beneficiaries to pay premiums.

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Are Medicaid Patients Getting High-Quality Primary Care?

Americans with Medicaid coverage tend to get their primary care from the only providers typically available to them — independent practices that often lack adequate resources. Do Medicaid’s low payment rates for office-based visits limit the quality of care they’re able to provide? According to a new study by New York University researchers, there is no significant difference, on average, in the quality of care delivered by primary care physicians who see only Medicaid patients and those who don’t see any.

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Continuity-of-Care Rules Can Help People Transition from Medicaid

Starting in April, states will once again be able to terminate Medicaid and Children’s Health Insurance Program coverage for people they deem ineligible. An estimated 15 million people could now lose Medicaid coverage, and only about half of them will be eligible for employer-sponsored or subsidized marketplace coverage. Those who successfully shift to a different coverage option face another hurdle — not being able to see providers they had access to through Medicaid. Georgetown University researchers show how state laws can preserve continuity of care and ease coverage transitions.

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Accounting for Social Risks in Medicare and Medicaid Payments

Clinicians know that patients’ social circumstances play an enormous role in their health. Robert L. Phillips and colleagues report on ongoing efforts to explore how Medicare and Medicaid payments might be adjusted so that clinicians and community organizations have the resources they need to help patients meet critical social needs. The authors also explore various metrics policymakers could use to measure social risk.

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A New Era in Telemedicine: What Comes Next?

How did the telemedicine boom during the COVID-19 pandemic impact health care performance across the globe, and what comes next? On January 31, the Commonwealth Fund, the Organisation for Economic Co-operation and Development (OECD), and the Institute of Global Health Innovation at Imperial College London hosted a virtual discussion on the future of telemedicine, findings from an OECD report examining the effects of remote care, and the national policies that led to its widespread use. View the archived webinar here.

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Everything You Wanted to Know About Value-Based Care

As we’ve said before, the United States spends far more on health care than other high-income countries but gets worse results. These problems stem in part from the way the U.S. pays for health care: generally, providers earn more if they deliver more services, even if patients don’t see the desired results. A Commonwealth Fund explainer explores the potential of what’s known as value-based care, which ties the amount health care providers earn for their services to the results they deliver.

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Reforming ERISA Would Help States Control Health Costs

For decades, the federal law known as ERISA — the Employee Retirement Income Security Act — has hobbled states’ efforts to regulate the employer-sponsored health insurance market. ERISA preempts state laws that regulate employer-sponsored health benefits, even when those laws don’t directly conflict with federal requirements. Boston University’s Elizabeth Y. McCuskey says bipartisan support may be growing for legislation that would provide states some flexibility to pursue measures for restraining ever-increasing health care costs.

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