| Hot Topic: Health Reform and Delivery System Organization |
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| Among the changes likely to flow from health reform is delivery system reform that promotes coordinated, accountable, high-quality and low-cost care. Mechanisms for promoting such care include accountable care organizations (ACOs), medical homes, and payment for the coordination of care. Recently, three HCFO grantees convened at AcademyHealth’s Annual Research Meeting to discuss strategies to improve our current system for delivering care.
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| HCFO Releases a New Issue Brief Examining Destabilization in the Individual Health Insurance Market |
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| The Patient Protection and Affordable Care Act (PPACA) was enacted on March 23, 2010. Under the new law, insurers will be required to meet minimum loss ratios (e.g. 80 percent in the individual market) or provide rebates to enrollees. For the individual market, the law gives the Secretary the authority to make adjustments to the percentage if she determines that the application of the 80 percent standard may destabilize that market in a state. If markets become unstable, consumers in the
individual market may be at risk for losing coverage and find they are unable to obtain replacement coverage. In June, the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization (HCFO) program convened an invitational meeting of experts, including industry analysts, insurers, actuaries, state regulators, federal policymakers, and academic researchers to discuss the medical loss ratio standard in the individual insurance market and provisions within the PPACA for
addressing the potential for market destabilization. For more information, see HCFO brief, “Recognizing Destabilization in the Individual Health Insurance Market” which provides an overview of the meeting discussion.
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| New Data for Researchers |
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The Agency for Healthcare Research and Quality released three reports on hospital readmissions, diagnostic groups with rapidly increasing costs, and mental health and substance abuse-related emergency department visits.
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| Grantee Spotlight: Matthew L. Maciejewski, Ph.D. |
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| Matthew L. Maciejewski, Ph.D., is the principal investigator for a HCFO study exploring the business case for value-based insurance design.
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| New Grantee Publications |
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| News and Events |
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Grantees in the News
Findings from a HCFO-sponsored study led by Laurence C. Baker, Ph.D., were featured in a recent article on the website of American Medical News. The article, “Physician payment can vary widely for same procedures,” highlighted findings that were presented in June at AcademyHealth’s Annual Research Meeting in Boston. The study found that physicians in the same geographic
area frequently are paid at different rates for the same task. While Baker acknowledged that variation might be due to the negotiating power of larger physician groups, he also stated there was an “element of randomness” in the varying rates, and that cutting fees at the top end of the pay scale may help to reduce costs.
HCFO News
The HCFO brief “Financing End-of-Life Care: Challenges for an Aging Population” was cited in a chapter on Medicare in the Alliance for Health Reform’s Covering Health Issues. This brief explores key themes associated with end-of-life care and highlights the need for future research.
Awards and Appointments
Harold S. Luft, Ph.D., director of the Palo Alto Medical Foundation Research Institute, was recognized for his contributions as a health services researcher, mentor, and editor in the June 2010 issue of Health Services Research. Dr. Luft completed HCFO grants that examined resource of and efficiency in episodes of care and administrative costs associated with third party payments.
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