Palliative care, health policy, and health reform

From the Health Affairs Blog:

In the United States, value is the new health care imperative – improving quality while controlling costs.  We spend nearly twice the rate of comparable nations, yet have poorer health outcomes.  In 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA), mandating a new emphasis on paying for value, not volume.

Our greatest opportunity to enhance value in US health care is to improve quality of care for older adults with serious illness – the group who uses the most health care services. Serious illness, in which patients are unlikely to recover, stabilize, or be cured, is life-altering for patients and family caregivers.  It includes advanced, symptomatic stages of diseases such as congestive heart failure, chronic lung disease, cancer, kidney failure, and dementia. Serious illness may also refer to the cumulative consequences of multiple conditions progressing over time, causing functional decline or frailty. 

We’ve made important progress in understanding high quality care for this population of patients.  Researchers have asked patients with serious illness and their families how they define high quality care.  Especially in serious illness, patients want control over treatment through shared decision-making.   Even when there is no cure, most patients still want health care that helps them live longer – but only if they can also get help with function, physical comfort, and attention to family, emotional and spiritual needs.

 Read the complete post here.

Webinar on insurance marketplace experience

From the Commonwealth Fund:

Join a Commonwealth Fund–sponsored webinar on the Affordable Care Act’s health insurance marketplaces, hosted by the Society of American Business Editors and Writers & the Georgetown University Health Policy Institute. Experts working with the three marketplace models—federal, partnership, & state—will assess progress in their states.

  • What: The Affordable Care Act’s Health Insurance Marketplaces: What’s the Experience So Far?
  • When: 22 Jan. 22, 2:00–3:30 p.m., EST
  • Panelists:  Erin Klug, health insurance exchange program manager, Arizona Department of Insurance; Jennifer Koehler, J.D., director, Illinois Health Insurance Marketplace; & Michael Marchand, director of communications, Washington Health Benefit Exchange
  • Moderator:  Kevin Lucia, J.D., project director of the Georgetown University Health Policy Institute’s Center on Health Insurance Reforms
  • For more information & to register, click here.


Implementing health reform: An October through December enrollment report

From the Health Affairs Blog:

On January 13, 2014, the Department of Health and Human Services released a report on the Health Insurance Marketplace covering the first three months of open enrollment, October 1 through December 28, 2013. The data are reported cumulatively over the three month period rather than only for December, recognizing the fact that enrollment is a process that happens over a period of time and thus data reported separately on a monthly basis could be duplicative. Nevertheless the trends are very clear: the federal and many of the state exchanges are now in business, and enrollment is increasing at a rapid pace.

As of the end of December 2,153,421 Americans had enrolled in a qualified health plan: 956,991 had selected a plan through the state exchanges; 1,196,430 through the federal exchange. Three times as many enrollees selected a plan through the state exchanges in December (729,000) than had done so in October and November (227,000); five times as many selected a plan through the federal exchange in December (1,059,000) than had done so in October and November (137,000).

As of December 28, 2013, the exchanges had received a total of 4,348,224 applications, covering 7,716,824 individuals. Of these individuals, 5,130,798 were determined eligible for enrollment in an exchange-qualified health plan; 1,584,509 were determined or assessed eligible for Medicaid or CHIP. These numbers were dramatically increased from the 2.3 million determined eligible for exchange coverage and 803,077 eligible for Medicaid as of the end of November. A recent survey by the Commonwealth Fund found that 59 percent of adults who are potentially eligible for exchange coverage, but who had visited the exchange and not enrolled or had not yet visited the exchange, planned to enroll by March 31, 2014, the end of the open enrollment period. It is likely that many of the three million who have been determined eligible but not yet enrolled will yet do so.

The December report reveals new information on enrollees who qualified for premium tax credits. In October only 30 percent of enrollees who were determined eligible for exchange enrollment were determined eligible for financial assistance; by November the percentage had climbed to 50 percent. In the December report that number climbed only marginally, to 53 percent. The December report for the first time, however, tells us the proportion of individuals who actually enrolled in a plan who received financial assistance: 78 percent in the state-based exchanges, 80 percent in the federal exchange. This is close to the level of subsidy-eligible exchange enrollees projected by the Congressional Budget Office and suggests that the exchanges are actually reaching the uninsured — those who could not have previously afforded health insurance — as well as individuals who had individual coverage previously but really could not afford it.

To read the complete post, click here.

Children’s EHR format available in USHIK

From the Agency for Healthcare Research & Quality (AHQR):

The Agency for Healthcare Research and Quality’s (AHRQ’S) Children’s EHR Format has moved to the United States Health Information Knowledgebase (USHIK). This  helps align the Children’s EHR Format with related knowledgebase information, such as IT artifacts related to meaningful use, health IT standards, & related clinical quality measures, as well as a friendlier user interface

The Children’s EHR Format, developed by AHRQ & the Centers for Medicare and Medicaid Services (CMS), with input from the American Academy of Pediatrics, was released in February 2013.  The Children’s EHR Format is a set of child-specific requirements (& other requirements of special importance for children) that an EHR should meet to perform optimally for the particular health care needs of children.

Find the Children’s EHR Format here under the “Child EHR Format” tab.  For more information, follow this link:

Making New York the healthiest state

From the Health Affairs Blog:

In early December, the New York State Health Foundation and the New York State Department of Health cosponsored a summit focused on improving population health, with the title, “Making New York the Healthiest State: Achieving the Triple Aim.” We had hoped to convince a critical mass of health sector leaders to come together for a day to begin to understand a simple but difficult task: how can we get to be as good at keeping New Yorkers healthy as we are at getting them better after they experience significant medical problems? . . .

[W]ithin two weeks of our announcement of the conference, we had 250 people filling the allocated slots and another 300 people on a waiting list hoping to attend the meeting. It turns out that the issue of keeping people healthy has taken hold. Also, to our surprise, there were as many people who were health care providers interested in attending as there were public health leaders.

What explains the interest? The presentations at the conference brought at least two answers. First, health care providers know that they are going to benefit financially from keeping people healthy and out of hospitals as capitated payment systems become more important in medical care financing.

Second, our city and state are getting refocused on the challenge of dealing with inequities, as a new mayor in New York City has struck a popular chord in saying that we are “two cities”—one challenged by low incomes, poor education access, and substantial chronic health problems and the other enjoying an exciting, vibrant economy and culture.

To read more, click here.

Better care at lower cost: Is it possible?

From the Commonwealth Fund:

Evidence continues to pour in that America’s sky-high health care spending is not only unsustainable, it isn’t making us any healthier either—especially compared with other advanced countries. But what are we to do about it?

In Better Care at Lower Cost: Is It Possible?, we examine the sources of high costs in the United States, the obstacles to getting them under control, and the promising public and private efforts under way to uncover the pathway to high-value health care.

Read more posts in the series Health Reform & You on the Commonwealth Fund web site.

Life expectancy approach for measuring disparities

From the Agency for Healthcare Research & Quality (AHRQ):

As a new way to measure health care disparities, a new AHRQ study proposes analyzing health insurance status and medical need over a typical lifetime by ethnic group. This life expectancy approach can estimate the number of years that racial/ethnic groups are subject to “health insurance double jeopardy,” which authors James Kirby from AHRQ and Toshiko Kaneda from the Population Reference Bureau describe as the state of being uninsured while also in lesser health and therefore at higher risk of needing medical care.

The researchers found that the expected years of life spent in “double jeopardy” were 11 years for Hispanics, 6 years for blacks, and 4 years for whites. The authors suggest this approach as a new way to monitor progress in eliminating disparities in insurance coverage, as called for by the Affordable Care Act.

The study, “‘Double Jeopardy’ Measure Suggests Blacks and Hispanics Face More Severe Disparities Than Previously Indicated,” appeared in the October issue of Health Affairs.

Med Students, Free Clinics, and a Library: A Few of My Favorite Things

The UM Student Run Free Clinic was featured in the Atlantic for the work they’re doing in Pickney, Mi. Every Saturday, three clinical and three pre-clinical med students (along with three UMMS  physicians) head a decommissioned branch of the Pickney Community Public Library to staff the entirely student run free clinic.

The clinic promises to alleviate the negative impact of health disparities in rural south east Michigan. Additionally, it gives students an opportunity to get hands on experience on tasks like physical exams, health histories and schedule appointments. Many medical schools in the U.S. have at least one free clinic associated with their institution.

In article in the  Atlantic did address some of the concerns with the student run clinic model. Some experts believe that the quality of care is compromised since, while others struggle with the morality of students practicing people who happen to be impoverished. However, the anecdotal evidence in favor of student run free clinics is strong. Chelsea Reighard, a student director, was quoted in the Atlantic saying:

“I feel like medical school can be really about yourself- how much I can learn, how much I can do. I really want to serve people and work with them to improve their health”

Hearsay or Fact: A Symposium on the Communication of the Affordable Care Act

“Hearsay or Fact,” a free symposium sponsored by the Center for Healthcare Research and Transformation, the Knight-Wallace Fellows at Michigan, & the University of Michigan Institute for Healthcare Policy & Innovation is scheduled for Monday, November 4, from 1:00 to 5:00 in the Michigan League Ballroom.  Participants include:


  • John Z. Ayanian, MD, MPP, Director, Institute for Healthcare Policy & Innovation
  • Michael F. Cannon, Director of Health Policy Studies, Cato Institute
  • Heather H. Howard, JD, Director, RWJF State Health Reform Assistance Network


  • Reed Abelson, health care business reporter, The New York Times
  • Steven Brill, author “Bitter Pill: Why Medical Bills are Killing Us,” TIME Magazine
  • Jonathan Cohn, senior editor, The New Republic; author of “Sick: The Untold Story of America’s Health Care Crisis—and the People Who Pay the Price”
  • Holman W. Jenkins, Jr., member editorial board and columnist, The Wall Street Journal
  • Sarah Kliff, health policy reporter, The Washington Post
  • Julie Rovner, health policy correspondent, NPR

For more information, visit the web site or contact  Heather Guenther



New database from CMS: Medicare Provider Charge Data

The Department of Health & Human Services has created a database that for the first time gives consumers information on what hospitals charge.  The data, on the charges for services that are provided during the 100 most common Medicare inpatient stays and 30 common outpatient services, show significant variation across the country and within communities.

For example, average inpatient charges for services a hospital may provide in connection with a joint replacement range from a low of $5,300 at a hospital in Ada, Okla., to a high of $223,000 at a hospital in Monterey Park, Calif.  Even within the same geographic area, hospital charges for similar services can vary significantly. For example, average inpatient hospital charges for services that may be provided to treat heart failure range from a low of $21,000 to a high of $46,000 in Denver, Colo., and from a low of $9,000 to a high of $51,000 in Jackson, Miss.

Access the database here and on the Health Statistics research guide.