LDI issue brief最新文献_第2页

Issue at the Heart of Advancing the De-Adoption of Low-Value Care. Proceedings from an expert roundtable. 推进低价值医疗弃用的核心问题。专家圆桌会议记录。

LDI issue brief Pub Date : 2017-04-01

Janet Weiner, Rebecka Rosenquist

{"title":"Issue at the Heart of Advancing the De-Adoption of Low-Value Care. Proceedings from an expert roundtable.","authors":"Janet Weiner, Rebecka Rosenquist","doi":"","DOIUrl":"","url":null,"abstract":"Identifying and paying for value has become a recurrent theme of health care reforms. Its corollary, reducing the prevalence of, and resources directed to, ineffective or marginally effective care, has received far less attention. In July 2016, the University of Pennsylvania’s Leonard Davis Institute of Health Economics (LDI) convened a diverse set of national leaders and stakeholders representing industry, think-tanks, provider and patient groups, and academic experts to tackle how health systems, payers, and providers can spur the ‘de-adoption’ of medical practices and technologies no longer considered valuable.\u0000While the roundtable of experts unanimously supports the need for de-adoption and current efforts to curb the use of low-value practices or technologies, they identified four specific polarities at the heart of the debate about how best to build the momentum around deadoption, and move it forward. They are: 1) value (targeting ineffective, even harmful, care or expanding efforts to address care of limited value); 2) resource allocation (spending less or redirecting spending); 3) quality improvement (a subset of QI or a distinct process); 4) level of intervention (policy, payment, provider, or organization). In addition to these polarities, several key questions emerged that form practical next steps for advancing de-adoption activities. With an eye toward advancing de-adoption, this brief summarizes the polarities and questions that suggest priorities for a future research agenda and policy-relevant action steps.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"21 6","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34929742","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

How Medicaid Enrollees Fare Compared with Privately Insured and Uninsured Adults: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016. 医疗补助计划参保者与私人参保和未参保成年人的比较:2016年联邦基金两年一次的健康保险调查结果。

LDI issue brief Pub Date : 2017-04-01 DOI: 10.15868/SOCIALSECTOR.27290

Munira Z. Gunja, S. Collins, D. Blumenthal, M. Doty, S. Beutel

引用次数: 5

Primary Care Appointment Availability and the ACA Insurance Expansions. 初级保健预约可用性和ACA保险扩展。

LDI issue brief Pub Date : 2017-03-01

Molly Candon, Daniel Polsky, Brendan Saloner, Douglas Wissoker, Katherine Hempstead, Genevieve M Kenney, Karin Rhodes

{"title":"Primary Care Appointment Availability and the ACA Insurance Expansions.","authors":"Molly Candon, Daniel Polsky, Brendan Saloner, Douglas Wissoker, Katherine Hempstead, Genevieve M Kenney, Karin Rhodes","doi":"","DOIUrl":"","url":null,"abstract":"In the current debate in Congress over the Affordable Care Act (ACA), the issue of provider access is a major concern. Fortunately, our 10-state audit study published in JAMA Internal Medicine finds that primary care appointment availability for new patients with Medicaid increased 5.4 percentage points between 2012 and 2016 and remained stable for patients with private coverage. Over the same period, both Medicaid patients and the privately insured experienced a one-day increase in median wait times.\u0000Higher appointment availability for Medicaid patients is a surprising result given the increase in demand for care from millions of new Medicaid enrollees. In this Issue Brief, we summarize our study’s findings, expand on possible explanations, and extend the analysis by examining the relationship between appointment availability and state-level Medicaid expansions. We find that access to primary care increased for Medicaid patients only in states that extended Medicaid eligibility to low-income, nonelderly adults. Combined, these results suggest coverage provisions in the ACA have not overwhelmed primary care capacity.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"21 5","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34886631","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

Effects of the ACA on Health Care Cost Containment. ACA对医疗保健成本控制的影响。

LDI issue brief Pub Date : 2017-02-01

Janet Weiner, Clifford Marks, Mark Pauly

引用次数: 0

Repealing Federal Health Reform: Economic and Employment Consequences for States. 废除联邦医疗改革:对各州经济和就业的影响。

LDI issue brief Pub Date : 2017-01-05 DOI: 10.15868/SOCIALSECTOR.26348

L. Ku, Erika Steinmetz, Erin Brantley, Brian K. Bruen

{"title":"Repealing Federal Health Reform: Economic and Employment Consequences for States.","authors":"L. Ku, Erika Steinmetz, Erin Brantley, Brian K. Bruen","doi":"10.15868/SOCIALSECTOR.26348","DOIUrl":"https://doi.org/10.15868/SOCIALSECTOR.26348","url":null,"abstract":"Issue: The incoming Trump administration and Republicans in Congress are seeking to repeal the Affordable Care Act (ACA), likely beginning with the law’s insurance premium tax credits and expansion of Medicaid eligibility. Research shows that the loss of these two provisions would lead to a doubling of the number of uninsured, higher uncompensated care costs for providers, and higher taxes for low-income Americans. Goal: To determine the state-by-state effect of repeal on employment and economic activity. Methods: A multistate economic forecasting model (PI+ from Regional Economic Models, Inc.) was used to quantify for each state the effects of the federal spending cuts. Findings and Conclusions: Repeal results in a $140 billion loss in federal funding for health care in 2019, leading to the loss of 2.6 million jobs (mostly in the private sector) that year across all states. A third of lost jobs are in health care, with the majority in other industries. If replacement policies are not in place, there will be a cumulative $1.5 trillion loss in gross state products and a $2.6 trillion reduction in business output from 2019 to 2023. States and health care providers will be particularly hard hit by the funding cuts.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"51 1","pages":"1-18"},"PeriodicalIF":0.0,"publicationDate":"2017-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88210832","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: 4

Managed Care. 管理式医疗。

LDI issue brief Pub Date : 2017-01-01 DOI: 10.4135/9781452240121.n205

J. Karberg

引用次数: 0

A Long Way in a Short Time: States' Progress on Health Care Coverage and Access, 2013-2015. 短时间内的漫漫长路:2013-2015年各州在医疗保健覆盖和获取方面的进展。

LDI issue brief Pub Date : 2016-12-21 DOI: 10.15868/SOCIALSECTOR.26152

S. Hayes, S. Collins, D. Radley, D. McCarthy, S. Beutel

{"title":"A Long Way in a Short Time: States' Progress on Health Care Coverage and Access, 2013-2015.","authors":"S. Hayes, S. Collins, D. Radley, D. McCarthy, S. Beutel","doi":"10.15868/SOCIALSECTOR.26152","DOIUrl":"https://doi.org/10.15868/SOCIALSECTOR.26152","url":null,"abstract":"Issue: The Affordable Care Act’s policy reforms sought to expand health insurance coverage and make health care more affordable. As the nation prepares for policy changes under a new administration, we assess recent gains and challenges. Goal: To compare access to affordable health care across the U.S. between 2013 and 2015. Methods: Analysis of most recent publicly available data from the U.S. Census Bureau and the Behavioral Risk Factor Surveillance System.\u0000Key findings and conclusions: Between 2013 and 2015, uninsured rates for adults ages 19 to 64 declined in all states and by at least 3 percentage points in 48 states and the District of Columbia. For children, uninsured rates declined by at least 2 percentage points in 28 states. The share of adults age 18 and older who reported forgoing a visit to the doctor when needed because of costs dropped by at least 2 percentage points in 38 states and D.C. In contrast, there was little\u0000progress in expanding access to dental care for adults, which is not a required benefit under the ACA. These findings illustrate the impact that policy can have on access to care and offer a focal point for assessing future policy changes.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"103 1","pages":"1-18"},"PeriodicalIF":0.0,"publicationDate":"2016-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85720520","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: 3

How Much of a Factor Is the Affordable Care Act in the Declining Uninsured Rate? 《平价医疗法案》对未参保率下降有多大影响?

LDI issue brief Pub Date : 2016-12-01 DOI: 10.15868/socialsector.26134

S. Glied, Stephanie Ma, Sarah Verbofsky

{"title":"How Much of a Factor Is the Affordable Care Act in the Declining Uninsured Rate?","authors":"S. Glied, Stephanie Ma, Sarah Verbofsky","doi":"10.15868/socialsector.26134","DOIUrl":"https://doi.org/10.15868/socialsector.26134","url":null,"abstract":"Issue: While the number of uninsured has decreased substantially since the Affordable Care Act (ACA) expanded coverage in 2014, questions remain about how\u0000much the economic recovery and other changes might have influenced this decline. Goal: Assess the direct impact of the ACA marketplaces and the Medicaid expansion on the uninsured rate among nonelderly adults. Methods: Analysis of insurance coverage rates before and after the ACA’s first open enrollment period (fall 2013 to spring 2014) using the National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance Survey (BRFSS). Key findings: Based on NHIS data, enrollment in ACA-related coverage options explains about 76 percent of the 4-percentage-point decline in the uninsured rate during the first open enrollment period. Marketplace enrollments reduced the adult uninsured rate by an estimated 1.7 percentage points to 2.3 percentage points. The effects were substantially more pronounced among adults eligible for income-related subsidies. Medicaid expansions in participating states further reduced the uninsured rate by an estimated 0.76 points to 1.0 points. Conclusion: The great majority of nonelderly adults who enrolled during the first open enrollment period would likely not have held health coverage without the ACA expansions.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"5 1","pages":"1-12"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75025628","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: 3

How High-Need Patients Experience Health Care in the United States. Findings from the 2016 Commonwealth Fund Survey of High-Need Patients. 在美国，高需求患者如何体验医疗保健。2016年英联邦基金对高需求患者的调查结果。

LDI issue brief Pub Date : 2016-12-01 DOI: 10.15868/SOCIALSECTOR.26066

Jamie Ryan, M. Abrams, M. Doty, Tanya B. Shah, E. Schneider

{"title":"How High-Need Patients Experience Health Care in the United States. Findings from the 2016 Commonwealth Fund Survey of High-Need Patients.","authors":"Jamie Ryan, M. Abrams, M. Doty, Tanya B. Shah, E. Schneider","doi":"10.15868/SOCIALSECTOR.26066","DOIUrl":"https://doi.org/10.15868/SOCIALSECTOR.26066","url":null,"abstract":"Issue: Health care costs are highly concentrated among people with multiple chronic conditions, behavioral health problems, and those with physical limitations or disabilities. With a better understanding of these patients’ challenges, health care systems and providers can address patients’ complex social, behavioral, and medical needs more effectively and efficiently. Goal: To investigate how the challenges faced by this population affect their experiences with the health care system and examine potential opportunities for improvement. Methods: Analysis of the 2016 Commonwealth Fund Survey of High-Need Patients, June–September 2016. Key findings and conclusions: The health care system is currently failing to meet the complex needs of these\u0000patients. High-need patients have greater unmet behavioral health and social issues than do other adults and require greater support to help manage their complex medical and nonmedical requirements. Results indicate that with better access to care and good patient–provider communication, high-need patients are less likely to delay essential care and less likely to go to the emergency department for nonurgent care, and thus less likely to accrue avoidable costs. For health systems to improve outcomes and lower costs, they must assess patients’ comprehensive needs, increase access to care, and improve how they communicate with patients.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"31 1","pages":"1-20"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82237978","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: 39

The Slowdown in Employer Insurance Cost Growth: Why Many Workers Still Feel the Pinch. 雇主保险成本增长放缓:为什么许多工人仍然感到手头拮据。

LDI issue brief Pub Date : 2016-10-26 DOI: 10.15868/SOCIALSECTOR.25785

S. Collins, D. Radley, Munira Z. Gunja, S. Beutel

{"title":"The Slowdown in Employer Insurance Cost Growth: Why Many Workers Still Feel the Pinch.","authors":"S. Collins, D. Radley, Munira Z. Gunja, S. Beutel","doi":"10.15868/SOCIALSECTOR.25785","DOIUrl":"https://doi.org/10.15868/SOCIALSECTOR.25785","url":null,"abstract":"Issue: Although predictions that the Affordable Care Act (ACA) would lead to reductions in employer-sponsored health coverage have not been realized, some of the law’s critics maintain the ACA is nevertheless driving higher premium and deductible costs for businesses and their workers. Goal: To compare cost growth in employer-sponsored health insurance before and after 2010, when the ACA was enacted, and to compare changes in these costs relative to changes\u0000in workers’ incomes. Methods: The authors analyzed federal Medical Expenditure Panel Survey data to compare cost trends over the 10-year period from 2006 to 2015. Key findings and conclusions: Compared to the five years leading up to the ACA, premium growth for single health insurance policies offered by employers slowed both in the nation overall and in 33 states and the District of Columbia. There has been a similar slowdown in growth in the amounts employees contribute to health plan costs. Yet many families feel pinched by their health care costs: despite a recent surge, income growth has not kept pace in many areas of the U.S. Employee contributions to premiums and deductibles amounted to 10.1 percent of U.S. median income in 2015, compared to 6.5 percent in 2006. These costs are higher relative to income in many southeastern and southern states, where incomes are below the national average.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"67 1","pages":"1-22"},"PeriodicalIF":0.0,"publicationDate":"2016-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83433568","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: 3