Regional Variations: The Use Of Hospitals, Home Health, And Skilled Nursing In Traditional Medicare And Medicare Advantage.

In the traditional Medicare program, the use of health care services-particularly postacute care-varies substantially across geographic regions. Less is known about such variations in Medicare Advantage (MA), which is growing rapidly. Insurers that are paid on a risk basis, as in MA, may have incentives and tools to restrain the use of services, which could attenuate geographic variations.

Assessing HITECH Implementation and Lessons: 5 Years Later.

Policy Points: The expansive goals of the Health Information Technology for Economic and Clinical Health (HITECH) Act required the simultaneous development of a complex and interdependent infrastructure and a wide range of relationships, generating points of vulnerability. While federal legislation can be a powerful stimulus for change, its effectiveness also depends on its ability to accommodate state and local policies and private health care markets. Ambitious goals require support over a long time horizon, which can be challenging to maintain.

Consumer Engagement in Health IT: Distinguishing Rhetoric from Reality.

Rationale: Policymakers want health information technology (health IT) to support consumer engagement to help achieve national health goals. In this paper, we review the evidence to compare the rhetoric with the reality of current practice.

Current Reality And Barriers: Our environmental scan shows that consumer demand exists for electronic access to personal health information, but that technical and system or political barriers still limit the value of the available information and its potential benefits.

Employing health information technology in the real world to transform delivery.

Objectives: Strong leadership and a supportive culture are critical to effective organizational transformation, but organizations pursuing change also need the infrastructure and tools to do so effectively. As policy makers seek to transform healthcare systems-specifically the delivery of care-we explore the real-world connection between health information technology (HIT) and the transformation of care delivery.

Study Design And Methods: This study is based on interviews with diverse federal and health system leaders and federal officials.

Evolving vendor market for HITECH-certified ambulatory EHR products.

Background: The ambitious goals of the Health Information Technology for Economic and Clinical Health (HITECH) Act require rapid development and certification of new ambulatory electronic health record (EHR) products.

Objectives: To examine where the vendor market for EHR products stands now and the policy issues emerging from the market's evolution.

Study Design: Descriptive study with policy analysis.

Making sense of the change in how Medicare Advantage plans are paid.

The Affordable Care Act has altered payment policy for private Medicare Advantage (MA) plans, with the goal of lowering costs closer to the level in traditional Medicare. Using newly available information on 2009 MA plan costs, this analysis com­pares plans' estimates of per capita costs for providing Parts A and B benefits to their enrollees, on a risk-adjusted basis, against what government data show to be the same costs for traditional Medicare program beneficiaries residing in the same county. It finds that on average, risk-adjusted MA plan costs were 4 percent higher than traditional Medicare costs (104%).

How to provide and pay for long term care of an aging population is an international concern.

As populations age, most industrialized nations are seeking to review the structure for their long term care programs with the goal of allocating better limited public resources to meet expanding needs. In this Commentary, I examine critical questions that define the way individual nations provide for the long term care needs of their aging populations. As examined by Asiskovitch, Israel's programs appear, in cross-national context, to have a broader reach and rely more heavily on community based services.

There is little experience and limited data to support policy making on integrated care for dual eligibles.

Coordinating care for the nine million elderly or disabled and low-income people who are dually eligible for Medicare and Medicaid is a pressing policy issue. To support the debate over this issue, we synthesized public data on how services are provided to dual eligibles receiving covered benefits in both programs. Our analysis confirmed that most dual-eligible beneficiaries receive benefits separately for each program through fee-for-service arrangements.

Obtaining providers' 'buy-in' and establishing effective means of information exchange will be critical to HITECH's success.

In enacting the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the American Recovery and Reinvestment Act, Congress set ambitious goals for the nation to integrate information technology into health care delivery. The provisions called for the electronic exchange of health information and the adoption and meaningful use of health information technology in health care practices and hospitals. We examined the marketplace and regulatory forces that influence HITECH's success and identify outstanding challenges, some beyond the provisions' control.

Identifying, monitoring, and assessing promising innovations: using evaluation to support rapid-cycle change.

The Center for Medicare and Medicaid Innovation (Innovation Center) was created by the Affordable Care Act to identify, develop, assess, support, and spread new approaches to health care financing and delivery that can help improve quality and lower costs. Although the Innovation Center has been given unprecedented authority to take action, it is being asked to produce definitive results in an extremely short time frame. One particularly difficult task is developing methodological approaches that adhere to a condensed time frame, while maintaining the rigor required to support the extensive policy changes needed.

Pathways to the use of health services research in policy.

Objective: To apply social science theory so as to define more explicitly the pathways that influence policy makers' use of health services research.

Methods: The analysis builds on a literature review and the author's observations. It identifies important social science concepts relevant to use of research in policy and organizational decision making.

Using qualitative and quantitative methods to evaluate small-scale disease management pilot programs.

Interest in disease management programs continues to grow as managed care plans, the federal and state governments, and other organizations consider such efforts as a means to improve health care quality and reduce costs. These efforts vary in size, scope, and target population. While large-scale programs provide the means to measure impacts, evaluation of smaller interventions remains valuable as they often represent the early planning stages of larger initiatives.

Medicare's private plans: a report card on Medicare Advantage.

With higher payments and expanded private-plan authority, Medicare Advantage (MA) has caused the market to grow. One in three Medicare beneficiaries with Part D now gets this coverage through MA. Analysis of the sources of and reasons for enrollment growth suggest a troubling report card.

Availability of data to measure disparities in leading health indicators at the state and local levels.

Objectives: Healthy People 2010 identifies the elimination of health disparities as a critical national goal. The article analyzes the availability of state and local data to support this work.

Methods: We assessed data availability for the 10 leading health indicators (LHIs), comprising a set of 26 measures.

Understanding a collaborative effort to reduce racial and ethnic disparities in health care: contributions from social network analysis.

Quality improvement collaboratives have become a common strategy for improving health care. This paper uses social network analysis to study the relationships among organizations participating in a large scale public-private collaboration among major health plans to reduce racial and ethnic disparities in health care in the United States. Pre-existing ties, the collaborative process, participants' perceived contributions, and the overall organizational standing of participants were examined.

Medicare Advantage in 2006-2007: what Congress intended?

Starting in 2006, almost all Medicare beneficiaries have at least one Medicare Advantage (MA) plan available to them. Although new regional preferred provider organization (R-PPO) plans authorized through the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 contribute to this growth, private fee-for-service (PFFS) plans are more numerous and more popular with beneficiaries. Almost 1.

Moving research into practice: lessons from the US Agency for Healthcare Research and Quality's IDSRN program.

Background: The U.S. Agency for Healthcare Research and Quality's (AHRQ) Integrated Delivery Systems Research Network (IDSRN) program was established to foster public-private collaboration between health services researchers and health care delivery systems.

Commercial health insurance: smart or simply lucky?

Changes in the commercial health insurance industry are less a strategic shift than a defensive reaction to forces the industry cannot control and risky opportunities the industry cannot pass up. Diversification into the public sector presents short-term gains for the insurance industry but leaves unchanged the fundamental challenge it faces: rapid and apparently uncontrollable growth in health care costs. Commercial insurers have not proved to be any better than public payers at controlling costs.

Quality improvement in Medicaid managed care: Experience of the best clinical and administrative practices initiative.

Background: The Best Clinical and Administrative Practices (BCAP) initiative is part of the Medicaid Managed Care Program (MMCP) operated by the Center for Health Care Strategies. Work groups of 10-12 plans addressed quality of care in designated areas.

Methods And Information Sources: The assessment of BCAP was part of a larger MMCP program evaluation funded by the Robert Wood Johnson Foundation.

Translating research to action: improving physician access in public insurance.

Policymakers continue to struggle with how to assure adequate access to physician services in public programs like Medicaid, State Children's Health Insurance Program, or other public coverage programs. In this article, we synthesize available research on this topic and provide a framework that policymakers may find useful in identifying and measuring barriers to care access, determining where and why problems exist, and identifying how to intervene. Using our experience constructing the framework, we also consider what observations can be drawn from this experience for those interested in the challenge of moving the insights from research to practice.

Private plans in medicare: another look.

Previous efforts by Congress to expand the role of private plans in Medicare have met with limited success. Although the same fate may befall Medicare Advantage (MA), authorized by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, the political environment has changed, and powerful political interests now support Medicare privatization. Only time will tell whether these interests--and the policies they are pursuing--will be sufficient to offset the barriers that historically have limited the role of private plans in Medicare.

Challenges in improving care for high-risk seniors in Medicare.

Despite strong interest in improving care for high-risk elders, demonstration projects typically show negative results. This paper examines one large foundation-sponsored initiative to gain insight on why success often is so elusive. The findings indicate that specific flaws in concept, design, and implementation each make it more challenging for demonstrations to achieve their intended goals, especially those involving cost and utilization reductions.

Geographic variation in medicare per capita spending.

Persistent, widespread variations in Medicare spending across the country are largely and well-documented. In 1996, Medicare per capita spending across the country ranged from $3,000 to $8,500. This synthesis examines the Medicare spending variation, underlying causes, possible solutions, and whether people in higher-spending areas receive better care.