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 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

A Broken Drug Development Process

Posted by Marianne Udow-Phillips on May 8, 2011

For years, many in the health policy world have talked about the emphasis that pharmaceutical manufacturers were putting on “me too” drugs – drugs that are structurally similar to existing drugs with only subtle differences. And for a long time, I have been reading articles about the lack of new drugs in the drug development pipeline – especially blockbuster drugs that break new ground in the treatment of disease.

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Tags: pharmaceutical industry, R & D, costs

Arizona and Bad Public Policy on Health Care

Posted by Marianne Udow-Phillips on January 10, 2011

The Arizona Medicaid program has been much in the news lately for its decisions to deny Medicaid coverage for certain transplants. The state has variously argued several things about these decisions. First, that these are evidence based decisions; that is, that the transplants were denied because the research shows that they don’t actually work. But, when challenged by transplant surgeons and others, the state has given other reasons for their denial, with cost being at the top of the list.

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Tags: health reform, costs, rationing, evidence-based care, Medicaid

The 10% Rule

Posted by Marianne Udow-Phillips on January 3, 2011

One of the big issues that prompted the passage of health reform last year was the 39 percent rate increase proposed by Anthem California for the individual market. That action both strengthened the will of the Democrats to enact health care reform and provided a clear cut talking point about the need for reform. As a result, one of the provisions included in the reform law was that health insurance premiums could not increase at “unreasonable rates”.

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Tags: health reform, insurance regulation, costs

A Case in Point: The Tangled Web of Misaligned Incentives and Health Care Costs in the U.S.

Posted by Marianne Udow-Phillips on December 13, 2010

In 2007, the COURAGE trial (aka: Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation –a mouthful!) results were reported in the New England Journal of Medicine. This study concluded that for those with stable coronary artery disease, the insertion of stents was no better than medication and lifestyle changes at preventing future heart attacks or strokes, nor did it extend life. There were different side effects from each approach but clinically, this trial supports the concept that the choice of treatment ought to be based on patient preferences unless there were unique clinical factors present. The COURAGE trial results were widely publicized and use rates of these procedures have declined overall since then.

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Tags: costs, incentives, cardiology, medical appropriateness

Actuarial Projections and the ACA: The Good News Story You Never Heard

Posted by Marianne Udow-Phillips on September 13, 2010

This week, the esteemed journal Health Affairs published the latest findings from the office of the Chief Actuary of the Centers for Medicare and Medicaid Services (CMS), with new estimates on the cost impact of the Affordable Care Act (ACA).

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Tags: health reform, costs

Pain Should Be Getting Our Attention!

Posted by Carmen R. Green, M.D. on August 23, 2010

The Affordable Care Act was signed into law on March 23, 2010. As health care reform is implemented and the United States continues to devote extensive resources to health care; there are real opportunities to improve health care quality and equity by improving pain care. Specifically, pain research practice and policy can substantively inform the broader national health care policy debate (Green 2008). Pain has reached epidemic proportions with nearly 100 million Americans living with acute, chronic, cancer pain or pain due to a terminal illness. Yet pain is a silent epidemic, and pain care is plagued by problems with access, assessment, treatment, quality, and disparities (Green, Anderson et al. 2003). Aging baby boomers and increased survival from catastrophic injuries, cancer, and diabetes will yield dramatic increases in the prevalence of pain and has long term implications on the nation’s health and well-being. The epidemic coincides with problems in health care access, quality, and disparities. Thus, undiagnosed, untreated, and under-treated pain is a significant public health problem.

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Tags: Health reform, costs, coverage, pain