Issue brief (Center for Studying Health System Change)最新文献

Small employers and self-insured health benefits: too small to succeed? 小雇主和自我保险的健康福利:太小而无法成功?

Issue brief (Center for Studying Health System Change) Pub Date : 2012-07-01

Tracy Yee, Jon B Christianson, Paul B Ginsburg

{"title":"Small employers and self-insured health benefits: too small to succeed?","authors":"Tracy Yee, Jon B Christianson, Paul B Ginsburg","doi":"","DOIUrl":"","url":null,"abstract":"Over the past decade, large employers increasingly have bypassed traditional health insurance for their workers, opting instead to assume the financial risk of enrollees' medical care through self-insurance. Because self-insurance arrangements may offer advantages--such as lower costs, exemption from most state insurance regulation and greater flexibility in benefit design--they are especially attractive to large firms with enough employees to spread risk adequately to avoid the financial fallout from potentially catastrophic medical costs of some employees. Recently, with rising health care costs and changing market dynamics, more small firms--100 or fewer workers--are interested in self-insuring health benefits, according to a new qualitative study from the Center for Studying Health System Change (HSC). Self-insured firms typically use a third-party administrator (TPA) to process medical claims and provide access to provider networks. Firms also often purchase stop-loss insurance to cover medical costs exceeding a predefined amount. Increasingly competitive markets for TPA services and stop-loss insurance are making self-insurance attractive to more employers. The 2010 national health reform law imposes new requirements and taxes on health insurance that may spur more small firms to consider self-insurance. In turn, if more small firms opt to self-insure, certain health reform goals, such as strengthening consumer protections and making the small-group health insurance market more viable, may be undermined. Specifically, adverse selection--attracting sicker-than-average people--is a potential issue for the insurance exchanges created by reform.","PeriodicalId":80012,"journal":{"name":"Issue brief (Center for Studying Health System Change)","volume":" 138","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30773969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Employer-sponsored health insurance: down but not out. 雇主赞助的健康保险:降但不降。

Issue brief (Center for Studying Health System Change) Pub Date : 2011-10-01

Jon B Christanson, Ha T Tu, Divya R Samuel

{"title":"Employer-sponsored health insurance: down but not out.","authors":"Jon B Christanson, Ha T Tu, Divya R Samuel","doi":"","DOIUrl":"","url":null,"abstract":"Rising costs and the lingering fallout from the great recession are altering the calculus of employer approaches to offering health benefits, according to findings from the Center for Studying Health System Change's (HSC) 2010 site visits to 12 nationally representative metropolitan communities. Employers responded to the economic downturn by continuing to shift health care costs to employees, with the trend more pronounced in small, mid-sized and low-wage firms. At the same time, employers and health plans are dissatisfied and frustrated with their inability to influence medical cost trends by controlling utilization or negotiating more-favorable provider contracts. In an alternative attempt to control costs, employers increasingly are turning to wellness programs, although the payoff remains unclear. Employer uncertainty about how national reform will affect their health benefits programs suggests they are likely to continue their current course in the near term. Looking toward 2014 when many reform provisions take effect, employer responses likely will vary across communities, reflecting differences in state approaches to reform implementation, such as insurance exchange design, and local labor market conditions.","PeriodicalId":80012,"journal":{"name":"Issue brief (Center for Studying Health System Change)","volume":" 137","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2011-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30237328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Rising hospital employment of physicians: better quality, higher costs? 医院聘用越来越多的医生:质量更好，成本更高?

Issue brief (Center for Studying Health System Change) Pub Date : 2011-08-01

Ann S O'Malley, Amelia M Bond, Robert A Berenson

{"title":"Rising hospital employment of physicians: better quality, higher costs?","authors":"Ann S O'Malley, Amelia M Bond, Robert A Berenson","doi":"","DOIUrl":"","url":null,"abstract":"In a quest to gain market share, hospital employment of physicians has accelerated in recent years to shore up referral bases and capture admissions, according to the Center for Studying Health System Change's (HSC) 2010 site visits to 12 nationally representative metropolitan communities. Stagnant reimbursement rates, coupled with the rising costs of private practice, and a desire for a better work-life balance have contributed to physician interest in hospital employment. While greater physician alignment with hospitals may improve quality through better clinical integration and care coordination, hospital employment of physicians does not guarantee clinical integration. The trend of hospital-employed physicians also may increase costs through higher hospital and physician commercial insurance payment rates and hospital pressure on employed physicians to order more expensive care. To date, hospitals' primary motivation for employing physicians has been to gain market share, typically through lucrative service-line strategies encouraged by a fee-for-service payment system that rewards volume. More recently, hospitals view physician employment as a way to prepare for payment reforms that shift from fee for service to methods that make providers more accountable for the cost and quality of patient care.","PeriodicalId":80012,"journal":{"name":"Issue brief (Center for Studying Health System Change)","volume":" 136","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30087572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Key findings from HSC's 2010 site visits: health care markets weather economic downturn, brace for health reform. HSC 2010年实地考察的主要发现是:医疗保健市场经受住了经济低迷，为医疗改革做好准备。

Issue brief (Center for Studying Health System Change) Pub Date : 2011-05-01

Laurie E Felland, Joy M Grossman, Ha T Tu

{"title":"Key findings from HSC's 2010 site visits: health care markets weather economic downturn, brace for health reform.","authors":"Laurie E Felland, Joy M Grossman, Ha T Tu","doi":"","DOIUrl":"","url":null,"abstract":"Lingering fallout--loss of jobs and employer coverage--from the great recession slowed demand for health care services but did little to slow aggressive competition by dominant hospital systems for well-insured patients, according to key findings from the Center for Studying Health System Change's (HSC) 2010 site visits to 12 nationally representative metropolitan communities. Hospitals with significant market clout continued to command high payment rate increases from private insurers, and tighter hospital-physician alignment heightened concerns about growing provider market power. High and rising premiums led to increasing employer adoption of consumer-driven health plans and continued increases in patient cost sharing, but the broader movement to educate and engage consumers in care decisions did not keep pace. State and local budget deficits led to some funding cuts for safety net providers, but an influx of federal stimulus funds increased support to community health centers and shored up Medicaid programs, allowing many people who lost private insurance because of job losses to remain covered. Hospitals, physicians and insurers generally viewed health reform coverage expansions favorably, but all worried about protecting revenues as reform requirements phase in.","PeriodicalId":80012,"journal":{"name":"Issue brief (Center for Studying Health System Change)","volume":" 135","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40112490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Physicians slow to e-mail routinely with patients. 医生与病人的常规电子邮件往来缓慢。

Issue brief (Center for Studying Health System Change) Pub Date : 2010-10-01

Ellyn R Boukus, Joy M Grossman, Ann S O'Malley

引用次数: 0

Even when physicians adopt e-prescribing, use of advanced features lags. 即使医生采用了电子处方，先进功能的使用也会滞后。

Issue brief (Center for Studying Health System Change) Pub Date : 2010-07-01

Joy M Grossman

{"title":"Even when physicians adopt e-prescribing, use of advanced features lags.","authors":"Joy M Grossman","doi":"","DOIUrl":"","url":null,"abstract":"Physician practice adoption of electronic prescribing has not guaranteed that individual physicians will routinely use the technology, particularly the more advanced features the federal government is promoting with financial incentives, according to a new national study from the Center for Studying Health System Change (HSC). Slightly more than two in five physicians providing office-based ambulatory care reported that information technology (IT) was available in their practice to write prescriptions in 2008, the year before implementation of federal incentives. Among physicians with e-prescribing capabilities, about a quarter used the technology only occasionally or not at all. Moreover, fewer than 60 percent of physicians with e-prescribing had access to three advanced features included as part of the Medicare and Medicaid incentive programs--identifying potential drug interactions, obtaining formulary information and transmitting prescriptions to pharmacies electronically--and less than a quarter routinely used all three features. Physicians in practices using electronic medical records exclusively were much more likely to report routine use of e-prescribing than physicians with stand-alone e-prescribing. systems. Other gaps in adoption and routine use of e-prescribing also exist, most notably between physicians in larger and smaller practices","PeriodicalId":80012,"journal":{"name":"Issue brief (Center for Studying Health System Change)","volume":" 133","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2010-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29143975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Innovations in preventing and managing chronic conditions: what's working in the real world? 预防和管理慢性病的创新:在现实世界中什么是有效的?

Issue brief (Center for Studying Health System Change) Pub Date : 2010-06-01

Alwyn Cassil

引用次数: 0

Electronic medical records and communication with patients and other clinicians: are we talking less? 电子病历和与病人和其他临床医生的交流:我们说话少了吗?

Issue brief (Center for Studying Health System Change) Pub Date : 2010-04-01

Ann S O'Malley, Genna R Cohen, Joy M Grossman

{"title":"Electronic medical records and communication with patients and other clinicians: are we talking less?","authors":"Ann S O'Malley, Genna R Cohen, Joy M Grossman","doi":"","DOIUrl":"","url":null,"abstract":"Commercial electronic medical records (EMRs) both help and hinder physician interpersonal communication--real-time, face-to-face or phone conversations--with patients and other clinicians, according to a new Center for Studying Health System Change (HSC) study based on in-depth interviews with clinicians in 26 physician practices. EMRs assist real-time communication with patients during office visits, primarily through immediate access to patient information, allowing clinicians to talk with patients rather than search for information from paper records. For some clinicians, however, aspects of EMRs pose a distraction during visits. Moreover, some indicated that clinicians may rely on EMRs for information gathering and transfer at the expense of real-time communication with patients and other clinicians. Given time pressures already present in many physician practices, EMR and office-work flow modifications could help ensure that EMRs advance care without compromising interpersonal communication. In particular, policies promoting EMR adoption should consider incorporating communication-skills training for medical trainees and clinicians using EMRs.","PeriodicalId":80012,"journal":{"name":"Issue brief (Center for Studying Health System Change)","volume":" 131","pages":"1--4"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29013789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Modest and uneven: physician efforts to reduce racial and ethnic disparities. 适度和不平衡:医生努力减少种族和民族差异。

Issue brief (Center for Studying Health System Change) Pub Date : 2010-02-01

James D Reschovsky, Ellyn R Boukus

引用次数: 0

Expectations outpace reality: physicians' use of care management tools for patients with chronic conditions. 期望超过现实:医生使用护理管理工具对慢性疾病患者。

Issue brief (Center for Studying Health System Change) Pub Date : 2009-12-01

Emily Carrier, James Reschovsky

{"title":"Expectations outpace reality: physicians' use of care management tools for patients with chronic conditions.","authors":"Emily Carrier, James Reschovsky","doi":"","DOIUrl":"","url":null,"abstract":"Use of care management tools--such as group visits or patient registries--varies widely among primary care physicians whose practices care for patients with four common chronic conditions--asthma, diabetes, congestive heart failure and depression--according to a new national study by the Center for Studying Health System Change (HSC). For example, less than a third of these primary care physicians in 2008 reported their practices use nurse managers to coordinate care, and only four in 10 were in practices using registries to keep track of patients with chronic conditions. Physicians also used care management tools for patients with some chronic conditions but not others. Practice size and setting were strongly related to the likelihood that physicians used care management tools, with solo and smaller group practices least likely to use care management tools. The findings suggest that, along with experimenting with financial incentives for primary care physicians to adopt care management tools, policy makers might consider developing community-level care management resources, such as nurse managers, that could be shared among smaller physician practices.","PeriodicalId":80012,"journal":{"name":"Issue brief (Center for Studying Health System Change)","volume":" 129","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28749653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0