CHRTlines

The Latest (Not Greatest) on Essential Benefits

Posted by Marianne Udow-Phillips on January 9, 2012

Well, the federal government has spoken about its intent with regard to defining essential benefits, and the answer is: leave it to the states. As Tim Jost notes in his latest blog post, there are some (probably, most) who assumed the Affordable Care Act would result in more uniformity in essential benefits across the country. But instead (no doubt bowing to a perceived political backlash at this time of difficult discourse in Washington, DC) the Obama administration decided to publish guidelines and establish broad parameters for essential benefits without going into the details.

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Tags: health reform, essential benefits, costs, health policy

Complexity and Confusion: The Challenge of Communicating the Affordable Care Act

Posted by Marianne Udow-Phillips on December 19, 2011

OK, I admit it: we made a mistake.

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Tags: ACA, reform, coverage, costs

The Unintended Consequences of Reimbursement Changes and Interplay with Practice Patterns

Posted by Marianne Udow-Phillips on December 5, 2011

As we continue to focus on health care spending, it is important to look at the tools we’ve tried already and learn from our experience – especially our mistakes.

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Tags: cost, SGR, politics, Congress, drugs

The Death of CLASS

Posted by Marianne Udow-Phillips on November 21, 2011

Last spring when my colleagues and I were teaching a class on health insurance in America at the U-M Ford School of Public Policy, we asked our students to write their final papers on what they would change about the Affordable Care Act. Three of our earnest and committed students took on the task of trying to make the Community Living Assistance Services and Supports program (CLASS Act) workable. All three came up with approaches for increasing enrollment in CLASS and making it more financially sustainable over the long term.

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Tags: ACA, cost, CLASS, long term care

Is a national health service really such a bad idea? The VA Example

Posted by Marianne Udow-Phillips on November 7, 2011

Many Americans have an almost visceral reaction against what is sometimes called "socialized medicine." Socialized medicine is often discussed in the context of the British Health Service – where the government is both the payer and the employer of those delivering care. But the irony is, we have a superb example of a very similar approach here in America: the U.S. Department of Veterans Affairs.

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Tags: quality, cost, VA

E-Prescribing: Waiting for the tipping point

Posted by Marianne Udow-Phillips on October 11, 2011

Many of those working to improve health care in America have advocated for the use of electronic prescribing as an important tool for improving patient safety and moderating health care cost trends. A recent report released by the U.S. Government Accountability Office (GAO) documents abuses in the Medicare drug benefit that underline the potential value of electronic prescribing tools. According to the GAO report, some beneficiaries were able to obtain more than a year’s worth of narcotics by “shopping” different doctors. Electronic prescribing tools can enable health plans, physicians, and pharmacists to detect doctor-shopping, and assure that multiple prescriptions are not filled for the same condition within a given time period. Such an approach can both protect the health of patients who may receive duplicate prescriptions in error, and prevent fraud and abuse by those who seek prescription drugs for non-medical purposes.

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Tags: e-prescribing, EMRs, cost, patient safety, drugs

Health Care Quality and Cost Improvement: State-based approaches can’t go it alone

Posted by Kevin L. Seitz on September 26, 2011

It is difficult to find an issue that is more politically contentious than health care; particularly the policy changes and programs that are needed to assure that Americans have access to needed care.  The liberal position tends to see health care as a right, and seeks a strong centralized public role in assuring that all Americans have access to the same kinds of benefits and care.  The conservative position sees fiscal and personal responsibility as the top priorities; tending to favor decentralized, private market solutions.

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Tags: quality, cost, politics, Medicaid, states

The Schizophrenia of Health Care Spending: Cost to Some and Revenue to Others

Posted by Marianne Udow-Phillips on September 6, 2011

In early August, when the debt ceiling agreement was reached, many news reports noted the agreement did nothing to address core reasons for the debt, namely: Social Security, Medicaid and Medicare. Indeed, nearly every article written about the debt ceiling talked about the need to “deal with” (aka: cut) Medicare, Medicaid, and Social Security.

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Tags: cost, Medicare, Medicaid, for-profit, nonprofit

The Changing World of Hospice Care

Posted by Marianne Udow-Phillips on August 8, 2011

When I was in graduate school and early in my career, hospices were viewed as one of the most altruistic components of the health care system. With a philosophy of caring holistically for those at the end of life by controlling symptoms, supporting families, and providing a “good” death (preferably at home), hospices seemed to represent the vision of compassion that should be embodied in a caring profession. Hospice care was formalized in Great Britain in the late 1960s, and federally funded in the U.S. for the first time in a 1979 demonstration project. The hospice benefit became a part of the Medicare program in 1982 and fully incorporated in 1986.

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Tags: hospice, costs, end of life, for-profit, non-profit

Cost Effective Care: How Do We Get The Waste Out of the System?

Posted by Marianne Udow-Phillips on July 25, 2011

In the May 18 issue of the New England Journal of Medicine, Rashi Fein and Arnold Milstein tackled the question of why evidence-based care diffuses so slowly. The article is compelling because of its fundamental conclusion: institutionalized interest group pressure against change in health care and consumer misunderstanding of health care financing make it hard to envision how health care spending could be reduced in significant ways.

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Tags: cost, evidence-based care, waste, ACA,