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Last Build Date: Mon, 22 May 2017 18:38:44 +0000

 



Insurers, Marketplaces Face Uncertainty As Parties Seek Further House v. Price Delay

Mon, 22 May 2017 17:49:32 +0000

On May 22, 2017, the House of Representatives and the Department of Justice jointly asked the District of Columbia Court of Appeals to continue to hold House v. Price in abeyance, presumably for another 90 days as contemplated by the court’s earlier order. The next status report would be due on August 20, 2017. The court is expected to respond to their request in the near future. Legal Background As readers of this Blog know, this case was known earlier as House v. Burwell. The Affordable Care Act (ACA) requires insurers to reduce out-of-pocket limits and other cost sharing for enrollees in marketplace silver plans with household incomes not exceeding 250 percent of the federal poverty level. The House challenged the federal government’s reimbursement of insurers for these payments under the ACA, claiming that no money had been appropriated and that the payments were thus unconstitutional. The lower court accepted the position of the House on this issue and enjoined the reimbursement until Congress appropriated funds to cover them, but stayed its order pending appeal. The Obama administration appealed. The House asked for additional time to respond, and then, after the election, sought a further delay to give the Trump administration time to develop a position in the litigation. The Trump administration has yet to take a position on whether the payments are legal or not. The Danger Of Continued Uncertainty For Insurers And The Marketplaces Leaving the appeal in abeyance leaves the insurance industry in limbo. It is being reported that the administration will continue making the payments while the case is pending, but the Trump administration has to date refused to commit itself formally to continue to make the payments for any definite period of time. President Trump has suggested several times that he might cut payments off or might use continued payment of the CSR reimbursement as a bargaining chip to get Democrats to support changes to the ACA. Insurers, however, must notify the federal government of their preliminary decision whether or not they will participate in the exchanges for 2018 by June 21. In most, if not all, states, they must file their rates for 2018 before that time. Final exchange-qualified health plan rates are due by August 16, 2017, before the next 90-day status call would be due. Approximately 7 million exchange enrollees qualify for cost-sharing reductions, nearly 60 percent of all enrollees. The cost-sharing reductions are expected to cost insurers that offer qualified health plans about $7 billion this year, more in coming years. The Kaiser Family Foundation projects that insurers would have to raise their silver plan rates by an average of 19 percent, 21 percent in Medicaid non-expansion states, above premium increases they would otherwise seek in order to cover lost CSR payments. As Oliver Wyman and the Urban Institute have pointed out, these premium increases would result in corresponding increases in premium tax credits, increasing the cost of the total subsidy program for the federal government, making it possible for persons eligible for premium tax credits to purchase bronze plans for free and gold plans for little more than silver plans, and making more people eligible for tax credits. The premium increases would also, however, make health insurance in the individual market unaffordable for many people whose income is too high to qualify for premium tax credits. These scenarios presume, however, that insurers would not decide that exchange markets, or even the individual market as such, are just too risky and abandon them. The individual market constitutes a small part of the total business of most larger insurers, which depend much more on the large group market, administering self-insured employer plans, and Medicare and Medicaid managed care. A number of insurers have already left the exchange or individual market in a number of states, and more will almost certainly follow if the CSR issue is not addressed. Within the past week the National Association of Insurance Commissioners [...]



Health Insurance Benefits Should Be Equitable, Not Necessarily Equal

Mon, 22 May 2017 14:29:38 +0000

As policy makers grapple with potentially undoing or modifying the largest expansion of health insurance in a generation, the cost and generosity of benefits hold center stage. Traditional underpinnings of insurance plans—premiums, deductibles, copayments, and coinsurance—frequently create barriers to the optimal use of these plans by consumers. They also can exacerbate inequities in health care, by inhibiting the use of services known to benefit health. Novel approaches to insurance plan design to produce a more equitable and efficient distribution of health care expenditures are warranted. Following the principle of equality, insurance benefit designs traditionally have offered the same benefit structure to all enrollees. Consumer cost sharing at the point of service is typically uniform regardless of need or potential clinical benefit—often it’s based on the acquisition cost. This one-size-fits-all mentality seems like a great idea on the surface but can create deeply unfair outcomes. For example, in a traditional tiered pharmacy benefit, patients have the same out-of-pocket cost for a life-saving cardiac drug as they do for a medication that treats an annoying, but ultimately benign, toenail fungal infection. Or, a patient with a chronic disease enrolled in a high-deductible health plan must pay the full cost of medications and supplies to control their illness until the plan deductible is met, reducing adherence to treatments that keep people healthier and offset later costs. Sometimes these examples are shared as unintended policy quirks of our current system, but when the issue is access to needed care, it becomes an awfully cruel joke. Instead, we should be designing insurance coverage in a way that provides access to care for people who need it, when they need it. That requires a subtle but important shift from equal access to equitable access. The first approach treats all people, regardless of clinical need, the same. The second recognizes that clinical need is an essential factor in determining where to direct resources and does not apologize for treating people with different needs differently. There are a number of innovations in plan design that address the issue of inequities, including pairing insurance benefits with social or clinical supports for people with chronic disease and enhancing coverage for products that improve upstream risk factors, such as the Diabetes Prevention Program. A feasible and effective approach to better aligning expenditures with patient-centered outcomes is value-based insurance design (VBID). VBID structures consumer cost sharing around the idea of clinical nuance, which recognizes that the value of medical services depends on who receives it, who provides it, and where it is provided. This nuanced strategy supports the goals of equity by reducing financial barriers to specific services for targeted populations who need them most. This approach can also be used to deter the use of services when there is low or no expected clinical benefit to the patient. To be sure, VBID addresses financial barriers to treatment, and there are myriad other access barriers that contribute to health inequities. Nevertheless, it represents an important step in promoting equitable access to care and the use of value in determining how to best spend limited health care resources. VBID is being used across a wide variety of populations in both commercial and government-funded health insurance, including Medicaid, collectively bargained benefits, and a large number of employer plans. In January 2017, the Centers for Medicare and Medicaid Services launched a Medicare Advantage demonstration permitting plans to offer, for the first time, a different level of benefits to Medicare Advantage members based on their clinical diagnoses. Still, there are barriers to implementing VBID in some settings, including traditional Medicare and in high-deductible health plans that include health savings accounts. Designs that fail to distinguish between differing needs [...]



The Humanity In End-Of-Life Care

Fri, 19 May 2017 14:14:30 +0000

Health care is personal, especially when it comes to caring for someone as they approach death. However, half of Americans feel they have too little control over end-of-life medical decisions. As the industry moves toward a more holistic approach to care delivery, health care organizations are beginning to rethink how they treat patients and starting to embed end-of-life care plans into the overall approach earlier on, sometimes before people even become ill. In a recent report on end-of-life care by the Aspen Health Strategy Group, several principles are discussed that take a broader view around caring for seriously ill patients, helping to ensure that care is sensitive, aligned with patient and family wishes, and always working toward enhanced quality of life. One of the top recommendations in the report to achieving that end is increasing emphasis on palliative care. Deemed the fastest-growing medical specialty in the United States, palliative care is interdisciplinary care (medicine, nursing, social work, chaplaincy, and other specialties when appropriate) that focuses on improving the quality of life for persons of any age with a serious illness, as well as for their families. While a relatively new concept, palliative care has been increasing in prevalence, in part due to new value-based care incentives that promote an environment in which payment relies on not only treating the illness but keeping patients comfortable and, when possible, at home. However, there is a significant misunderstanding about what defines effective palliative care among patients and providers. Palliative care is about proactive care, which can be used at any point in an illness. Unlike hospice, palliative care is not just for those who are dying; it can be delivered to anyone with a serious or chronic medical condition from the time of diagnosis, regardless of whether the patient is terminally ill, expected to recover fully, or facing years of chronic or progressive disease. It is often provided at the same time as curative medical regimens to help patients tolerate side effects of disease and treatment, while carrying on with everyday life. This includes social, emotional, and spiritual support, as well as advising families on how to care for their loved ones. Effective Palliative Care Improves Patient Experience In dealing with these illnesses at the time of diagnosis through palliative care, caregivers can greatly increase patient satisfaction and outcomes, while reducing costs. For example, one of Premier, Inc.’s (a health care improvement company) members, Presbyterian Healthcare Services, in Albuquerque, New Mexico, launched palliative care outpatient clinics in 2012 and now offers them at three primary-care offices and two oncology offices. In a 2014 cost comparison of patients’ costs in the six months before their first visit to a Presbyterian outpatient clinic to the six months after, hospitalization costs dropped by 19 percent, use of outpatient hospital services went down by 44 percent, and emergency department costs decreased by 79 percent. All of this was done while maintaining quality. And they’ve continued to expand these services by creating a more robust home palliative program with 24/7 access to trained professionals. Acute care hospitalization rates for these patients are now extremely low when compared to national or regional norms. Research has also shown advantages in administering palliative care. In a randomized trial of patients with metastatic non-small-cell lung cancer, those assigned to early palliative care not only experienced a better quality of life and fewer symptoms of depression than patients receiving standard care, but they also lived more than two months longer. Health systems in Premier’s quality improvement and population health collaboratives are sharing their best practices in palliative care and implementing effective models across the continuum to make them available in outpatient settings, nursing homes, and at home. They are also d[...]



California, New York Lead Group Of States Seeking To Intervene In Litigation Over Cost-Sharing Reduction Payments

Thu, 18 May 2017 18:39:39 +0000

On May 18, 2017, attorneys general from 15 states and the District of Columbia, led by California and New York, filed a motion to intervene in House v. Price, formerly known as House v. Burwell. They also filed a motion to lift the current court order holding the case in abeyance to the extent necessary to consider their motion to intervene. The Legal Lay Of The Land As readers of Health Affairs Blog know well, this is the case filed in November, 2014, by the House of Representatives to challenge certain actions taken by the Obama administration to implement the Affordable Care Act. One of the actions challenged was the administration’s reimbursing insurers for their reductions in out-of-pocket limits and other cost sharing required by the ACA for individuals and families with incomes between 100 percent and 250 percent of the federal poverty level who enroll in silver (70 percent actuarial value) plans. The House claimed that Congress never appropriated money to fund these payments, and therefore the administration was making them unconstitutionally. In May of 2016, Judge Rosemary Collyer ruled in the House’s favor on this claim, holding that Congress had not appropriated money to cover the cost sharing reduction (CSR) payments. She enjoined future payments until Congress appropriated funds. Judge Collyer stayed her order pending appeal. The Obama administration did appeal to the District of Columbia Circuit Court of Appeals, filing its initial brief in October, 2016. The House asked for additional time to file its responsive brief. Then, when the election brought the Trump administration into office, the House asked that the appeal be stayed until the new administration took a position on the issue. At this point, pursuant to a further request from the House and the Trump administration for delay, the appeal remains in abeyance with the next status call scheduled for Monday, May 22, 2017. In late December, 2016, two enrollees who receive CSRs filed a motion to intervene in the appeal. They claimed that their interests would be seriously injured if the appellate court allowed the lower court’s decision for the House to go into effect, and that the Trump administration did not adequately represent their interests in the appeal. After requiring briefs on the issue, the D.C. Circuit dismissed their motion to intervene in a one paragraph unsigned order, simply stating that the requirements for intervention had not been met without further explanation. What The States Argue The states’ motion contends that allowing the lower court’s order ending the CSR payments until Congress appropriates funding, and subjecting future CSR payments to an unpredictable appropriations process, would lead to higher insurance costs for consumers and to more insurers abandoning the individual health insurance market. This in turn would increase the number of uninsured, “hurting uninsured individuals and directly burdening the States.” They argue: “At a minimum, the annual uncertainty created by the district court’s decision would make the States’ task in regulating and providing health insurance to their residents more complex, unpredictable, and expensive.” The states further assert that the Trump administration is not adequately representing their interests in the litigation, and that they must be allowed to intervene to ensure that those interests are protected. To establish a right to intervene in an appeal, a party must show under federal rules that: Its motion is timely, It has a legally protected interest in the action, The outcome threatens to impair that interest, and No existing party adequately represents the intervener’s interest. The states first argue that their motion is timely. The Obama administration vigorously defended its authority to reimburse the insurers for the CSRs without an appropriation additional to that provided by the ACA itself as long as it was in office. It opposed the motion by enrollees to intervene in [...]



Preserving The Bipartisan Commitment To Health Care Delivery System Reform

Thu, 18 May 2017 16:00:28 +0000

Editor’s Note: This is the first in a five-part Health Affairs Blog series, produced in conjunction with the Bipartisan Policy Center, examining current issues and care models in the delivery system reform effort. Each post will be jointly authored by Democratic and Republican leaders in health policy. Check back for the next entry in the series on May 25. Improving and reforming our health care delivery system is not a partisan issue. The need to improve health care delivery models, as a means for ensuring better patient outcomes and a more efficient health care system, enjoys broader consensus than elements surrounding health insurance coverage and financing. It is important for Congress, the Trump administration, and the health care industry to continue bipartisan efforts to shift our health care delivery system and provider payment models toward value-based care. The Long History Of Bipartisanship In Medicare For more than 30 years, Democrats and Republicans have worked together on incremental approaches to fostering smarter payment models in federal health programs, which seek to reward providers and health plans for delivering cost-efficient, high-quality care. In 1983, Democratic and Republican leaders of the Senate Finance Committee and House Ways and Means Committee agreed to modernize Medicare’s payment system for inpatient hospital stays, moving from cost-based reimbursement to a pre-set prospective payment for a duration of care for a specific condition. In 2000 and again in 2003, Congress enacted bipartisan legislation to authorize Medicare payment demonstrations that laid the groundwork for the accountable care organization and bundled payment programs that are in operation today. Most recently, Democrats and Republicans worked together to pass the Medicare Access and CHIP Reauthorization Act of 2015, which reshaped Medicare’s payment system for physician and practitioner services to better link payment to quality performance and encourage clinician participation in alternative payment models. The passage of the 21st Century Cures Act last December was also bipartisan legislation. It created policies to address site-of-service payment differences in our health care delivery system, while improving interoperability of health information technology systems. It is critical that we continue to build upon these delivery reform efforts, as shifting payment incentives for both providers and managed care plans represents our best chance to improve quality and control health care cost growth without limiting access to services or reducing the scope of covered benefits. While many programs are still working through growing pains, we have some early evidence of success. Medicare’s voluntary bundled payment program for orthopedic surgery cases produced savings of $864 per 90-day episode of care, on average during 2014. Meanwhile, the Independence at Home Demonstration resulted in average annual savings of $3,070 per participating beneficiary in the demonstration’s first year of operation. Under this demonstration, primary care practices share in Medicare savings that result from care coordination and in-home visits tailored to chronically ill patients’ needs. Finally, a recent Medicare demonstration to address avoidable hospitalizations among nursing home residents showed significant reductions in avoidable hospital admissions, achieved through enhanced medication management and nurse-led care coordination across primary and specialty care. In continuing implementation of delivery system reform, policy makers must work to develop payment models that avoid unneeded complexity. The new payment arrangements must be understandable to participating providers and patients, to achieve necessary engagement of both patients and providers in the care model. The Broader Landscape For Delivery System Innovation The delivery system innovation movement allows for the prospect of federal health programs building o[...]



A Consumer-Centered Framework For Quality: How Do We Get There From Here?

Thu, 18 May 2017 15:32:49 +0000

When buying a car, consumers are able to readily review some critical pieces of information, such as the price of the car; the mileage per gallon; what other owners thought of that model’s reliability; and how the car handles on various road tests. When it comes to health care, however, consumers aren’t able to easily obtain the few, key summative, consumer-facing measures that could help them understand the quality of their care. This isn’t because we don’t have quality measures in health care. To the contrary — there are in fact hundreds of measures. But these measures tend to be narrow in their scope (for example, management of diabetes or congestive heart failure, or ensuring that a colonoscopy was done for preventive care) making them hard to connect to a broader understanding of quality. The shift to population-based payment in particular has unmasked the gap in “big dot” measures necessary to capture overall system performance. Production vs. Consumer Measures In other words, what we have in health care are numerous “production” measures, but very few “consumer” measures. Production measures, in the case of the car, would be the thousands of things the manufacturer needs to know in order to produce a high-quality car: how efficiently and reliably each and every step in the manufacturing process is completed, how much variance there is in the dimensions of a particular part, or the tensile strength of a particular type of steel, for example. These two sets of measures—production and consumer—both reflect the quality of the product and both are important. However, they tell us fundamentally different things. While we have hundreds of production measures in health care, we have very little understanding of the measures consumers want and need. This is not particularly surprising, as quality measures tend to be created by people who are (or relate to) producers of health care, rather than the end users. Building An Infrastructure For Consumer Engagement In Quality Measurement Viewing quality measurement through the lens of production and consumer measures presents a deceptively simple and obvious solution: get consumers to develop the measures they want. Yet in the existing process for quality measure development, creating this consumer-centered measurement system is no easy task. Research conducted by the RAND Corporation with the Center for Consumer Engagement in Health Innovation identified barriers to effective consumer engagement in quality measurement. These include a lack of consumer resources for participation in the measure development process, difficulty in achieving sufficiently powerful consumer representation through the typical model of “multi-stakeholder” representation, and requests for overly technical input. It’s time for a different approach. The current system for engagement often gives consumers a handful of seats at a very crowded table and asks them to vie with other stakeholders to be heard. Instead, there should be recognition that the role of consumer input is fundamentally different from that of other stakeholders. The engagement process should be redesigned to reflect the distinction between production and consumer measures, with the explicit goal of harnessing consumer voices to craft and shape consumer-centered measures. For this engagement to be successful, an infrastructure for consumer engagement is needed. Consideration should be given to a consumer network that is constructed around local communities. In these communities, local consumer advocates or leaders could serve as hubs for organizing and engaging consumers. This approach is particularly important to consider when it comes to engaging harder to reach populations like low-income or other marginalized communities, people with behavioral health conditions, and people with a complex illness. This structure would allow consumers to engage and connect wi[...]



Toward A New Model For Promoting The Development Of Antimicrobial Drugs

Thu, 18 May 2017 14:20:54 +0000

As global health leaders gather in Berlin from May 19–20 for the first-ever G20 Health Ministers’ meeting, one of the main topics of discussion is expected to be how to best fight the threat of antimicrobial resistance (AMR). This reflects the growing recognition that AMR poses a significant threat to human health. An influential 2014 report by the Review on Antimicrobial Resistance, commonly referred to as the O’Neill Commission, estimated that antimicrobial-resistant infections currently claim 700,000 lives worldwide each year, a figure that could rise to as high as 10 million deaths per year by 2050. Estimates suggest that AMR could reduce world gross domestic product by 2–3 percent per year, imposing trillions of dollars in global economic burden. Proposals to combat AMR are usually built around two pillars. The first is to extend the effective life of the existing stock of antimicrobials with disease prevention and measures to combat overuse. The second is to promote the development of new antimicrobial medications to fight drug-resistant infections. While both are critical to solving the problem of AMR, there are inherent structural barriers that limit the usefulness of traditional incentives for promoting the development and effective stewardship of new antimicrobials. While the O’Neill Commission and others have made specific recommendations about policies to overcome these barriers, each proposed solution comes with its own set of costs and benefits. Thus, questions remain about the most efficient long-term solution to tackling the problem of AMR. The Rationale For Intervention The US patent system incentivizes innovation by offering the creator of a new technology monopoly power over its use for a fixed period of time. Although monopolies are usually considered inefficient, the potential for profit makes it worthwhile for innovators to undertake the costs and risk associated with research and development. An attractive feature of this system is that, in theory, monopoly prices are based on consumer willingness to pay, which in turn reflects the value of the innovation. In the case of medications, we would thus expect market forces to give manufacturers incentives to invest in the development of new treatments that offer the most value to patients (Note 1). However, while the development of new antimicrobials to combat AMR would seem to offer high value, our current system offers insufficient incentives to invest in them. This is because the profit from a new drug is mechanically related to the number of people who take it. In the case of antimicrobials, more use of a specific agent eventually leads to resistance, so the highest societal value from new antimicrobials comes when they are used as little as possible until needed. This significantly undermines the incentives for manufacturers to invest in the development of a new antimicrobial drug. Efficient incentives will come from policy interventions that dampen the tie between manufacturer profits and the volume of antimicrobial use. Policy Alternatives Policy levers designed to increase innovation are typically divided into “push” and “pull” mechanisms. Push mechanisms are supply-side policy tools that make innovation less expensive, such as a direct research and development subsidy. Pull mechanisms, including patents, are demand-based tools designed to make the market more attractive for a successfully developed product. In the case of AMR, the fact that the new drugs are intended to have limited initial use means that the current patent system provides insufficient pull incentives. This limited initial use also undermines the value of push mechanisms used in isolation; there is little point subsidizing research and development for a product that does not have a profitable market. Thus, while push incentives may be useful in the long run, we view reforms that generate pul[...]



CMS To Expand Direct Enrollment On HealthCare.gov

Wed, 17 May 2017 21:12:31 +0000

On May 17, 2017, the Centers for Medicare and Medicaid Services released a guidance outlining a new “proxy direct enrollment pathway” that will be available for the 2018 individual market open enrollment period. The press release accompanying the guidance states that the new process “reduces needless regulatory burden for businesses that provide direct enrollment services and offers consumers easier access to healthcare comparisons and shopping experiences for coverage offered through HealthCare.gov.” The new direct enrollment process, however, also carries risks for consumers; these are acknowledged in the guidance but may not be adequately addressed. Consumers currently have several options for enrolling in marketplace coverage through HealthCare.gov. Consumers can obviously enroll themselves using the HealthCare.gov website. Alternatively, a consumer can go to an agent or broker, who can walk the consumer through the enrollment process “side-by-side.” Finally, a consumer can enroll through an agent or broker, web-broker, or insurer using the current “direct enrollment” process. Under this process, the consumer initially goes to the web-broker or insurer’s website, is directed to HealthCare.gov to enter eligibility information and get an eligibility determination, and is then redirected to the web-broker or insurer’s website to enroll in coverage. HHS has considered for some time creating an enhanced direct enrollment process through which the consumer could complete the entire HealthCare.gov enrollment process remaining on the web-broker or insurer’s website. This possibility was discussed in both the 2017 and 2018 payment rule preambles. In the preamble to the final 2018 payment rule, HHS noted that the enhanced direct enrollment process was still under development. How The New Enrollment Process Will Work The new proxy direct enrollment pathway, which will be available for 2018 enrollments, functions like the envisioned enhanced direct enrollment process but is apparently a temporary step toward the final development of that process. The process will only be available for the federally facilitated exchange and for state-based exchanges using HealthCare.gov. Individual consumers will have to create their own HealthCare.gov accounts to use the process. Proxy direct enrollment will only be available for simple cases and not for complex enrollments, special enrollments, or terminations; people in those situations will need to proceed through the current “double redirect” process. The direct enrollment (DE) entity will have to check to determine if an existing application/enrollment is present for consumers and to use the current application or enrollment to help the consumer. Subject to these limits, however, applicants and enrollees using the new process will be able to complete the process of determination of marketplace, premium tax credit, and cost-sharing reduction payment eligibility, as well as qualified health plan (QHP) enrollment, on a DE entity’s websites. Concerns For Consumers Serious concerns have been raised about an enhanced direct enrollment process that are addressed at least in part by the guidance. One concern is the protection of very private personal and financial information that consumers will have to provide to DE entities for enrollment purposes. The guidance says that CMS “may release” future guidance on privacy and security requirements, and also that privacy and security issues will be a subject for the third-party compliance audits that DE entities must undergo. Another concern is that consumers receive necessary information on next steps they may have to take to establish eligibility, such as providing documentation where data matching issues arise or for special enrollment eligibility verification. Consumers must also to be informed of the tax liability implications of[...]



Health Affairs Web First: ACA Improved Medical Care And Health Among Low-Income Adults

Wed, 17 May 2017 20:03:15 +0000

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As the Senate evaluates potential changes to the Affordable Care Act (ACA), a new study, released today by Health Affairs as a Web First, examines the effects of gaining insurance coverage. The authors evaluated telephone survey data of low-income adults from 2013 through 2016 in three states: Kentucky, which expanded Medicaid; Arkansas, which expanded private insurance to low-income adults through the federal Marketplace; and Texas, which did not expand coverage to this group.

According to the study, by the end of 2016, the uninsurance rate in the two expansion states (Kentucky and Arkansas) had dropped by more than 20 percentage points relative to Texas. For the newly insured, this change was associated with a 41-percentage-point increase in having a usual source of care, a $337 reduction in annual out-of-pocket spending, significant increases in preventive visits and glucose screening tests, and a 23-percentage-point increase in “excellent” self-reported health. The authors calculated a 56-percentage-point increase in obtaining regular medical care for those in the sample with chronic health conditions.

“As policy makers debate the ACA’s future and additional states consider whether to expand Medicaid, our findings demonstrate the benefits associated with coverage expansion for low-income adults, including those with chronic conditions,” the authors conclude. “With the Arkansas and Kentucky approaches producing similar results, our results imply that while coverage expansion is important for patients, the type of coverage obtained is less critical.”




New RWJF Funding Opportunities Promote Access To Health Data For Researchers And Others

Wed, 17 May 2017 16:49:30 +0000

Data-related grant making is a time-honored philanthropic tactic. In the early twentieth century, the Russell Sage Foundation, among others, conducted some of the first social science surveys as it attempted to increase awareness of social problems. Funding surveys and promoting the dissemination of existing government data continue to be important activities for foundations. But as sources of data and ways of working with data change, opportunities for data-related grant making change as well. A few recent projects at the Robert Wood Johnson Foundation (RWJF), where I work, reflect its evolving interest in promoting access to data. Several weeks ago we announced a new call for proposals (CFP) called Health Data for Action: Leveraging Health Data for Actionable Insights (HD4A). This new opportunity for investigator-initiated research attempts to increase access to highly valued data sets that are often prohibitively expensive or otherwise difficult for researchers at universities or government agencies to obtain. At the same time, by partnering with data owners, we hope to also raise their awareness of the value of their data. For the first round of this new CFP, we are working with two longstanding partners that have outstanding data—athenahealth and the Health Care Cost Institute (HCCI). As a result of RWJF funding, these partners will provide access to their data, at no cost, to successful applicants. Athenahealth is a cloud-based medical software company that has data on millions of patient visits. For this opportunity, the company is making available data related to body mass index (BMI), including patient demographics, payer characteristics, and information about chronic conditions. The HCCI is another well-known source of health data of great value to researchers. This nonprofit is a multipayer claims database containing millions of commercial insurance claims. The HCCI is making available claims data that include details of health services utilized and payment information. Both of these partners work with us on other data-related projects. For example, our collaboration with athena has resulted in timely monitoring of trends related to many aspects of patient visits to physicians’ offices. With the HCCI, we have been working on a unique surveillance effort, the Healthy Marketplace Index, which attempts to use the HCCI’s rich claims data to characterize prices, utilization of care, and competition in various health care markets. The HD4A call for proposals will fund approximately five proposals in this round, with each grantee receiving approximately $150,000 over one year. AcademyHealth recently held a webinar on the HD4A opportunity, which can be viewed here. More than 600 people participated in the webinar. Brief proposals are due on May 24 at 3 p.m. ET. Data partners will work with us to assess whether applicants’ ideas are well suited to the data, and proposals will be externally reviewed. Depending on the level of interest and the quality of the projects, we may repeat this opportunity next year, potentially with some new data partners. As always, we are eager for suggestions about potential partners and ways to improve this funding opportunity. Another project, which we announced in April, is not technically new but has evolved considerably since its inception. Since 2014 the RWJF has been attempting to produce a plan-level data set for the research community. The project, Health Insurance Exchange Comparison (HIX Compare),  began as a public-use file of silver plans on the Affordable Care Act (ACA) exchanges in all fifty states. Since then, we have worked with a number of different partners and slowly expanded the universe of what is included. At this point, HIX Compare includes rate and benefit information in standardized categories for the entire ACA-com[...]