Transforming Health Care Through Evidence and Collaboration
Transforming Health Care Through Evidence and Collaboration
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Health Care Coverage

  • Technology has revolutionized consumerism, allowing us to make on-the-go purchasing decisions with user-friendly apps and easy access to product data. We're also increasingly sophisticated about monitoring our health, turning mobile devices into wellness tools with calorie trackers and fitness monitors. While the health care industry has largely lagged behind this transformation, more and more companies are finding ways to help consumers take charge of their health and make smart decisions about their health care.

  • In this essay, Dr. Anthony Lo Sasso provides empirical evidence of the adverse selection that resulted when states adopted community rating and guaranteed issue requirements in their individual health insurance markets.

  • The health insurance exchange is one of the centerpieces of the Patient Protection and Affordable Care Act, promising to increase transparency and reduce premiums. Some states are successfully forging ahead with exchange implementation, while others are stymied by political uncertainties.

  • This data brief offers a comprehensive look at how employer-sponsored insurance has been changing and how provisions of the ACA and other dynamics might affect this market.

  • An Honorable Mention for the 18th Annual Health Care Research Award has been awarded to “Full Coverage for Preventive Medications after Myocardial Infarction” in the New England Journal of Medicine in 2011. The paper looks into whether eliminating out-of-pocket costs would increase medication adherence after myocardial infarction and finds that the elimination of copayments did not significantly reduce rates of the trial's primary outcome. Additionally, enhanced prescription coverage improved adherence and rates of first major vascular events and decreased patient spending without increasing overall health costs.

    Research team: Niteesh Choudhry, Jerry Avorn, Robert Glynn, Elliott Antman, Sebastian Schneeweiss, Michele Toscano, Lonny Reisman, Joaquim Fernandes, Claire Spettell, Joy Lee, Raisa Levin, Troyen Brennan, William Shrank

  • Nearly one million children gained health care coverage in 2014, and the extension of CHIP earlier this year preserved coverage for millions more. Yet there are still many challenges in keeping kids covered, including variations in state Medicaid policies and funding for CHIP beyond 2017.

  • With exchange open enrollment set to begin October 1, 2013, the federal government—now responsible for at least partial marketplace facilitation in 33 states—has perhaps the largest role to play in meeting the deadline. Ongoing discussions on Medicaid expansion and the premium assistance option have added to uncertainty about the size and composition of the exchange markets. Meanwhile, this unpredictability is challenging insurers as they work to design and competitively price qualified health plans, with consumer choice and plan affordability at stake.

  • This webinar, hosted by Alliance for Health Reform with support from NIHCM Foundation, explored different scenarios affecting private insurance markets and consumers.

  • This NIHCM-funded study is investigating how referral patterns are influenced both by the ownership structures of physician groups and hospitals and by limited-network insurance plans. Findings have the potential to inform regulatory policy on hospital and physician group mergers and on network adequacy.

  • Women who are insured during pregnancy have better access to prenatal care and early screenings and are less likely to face preterm birth and low birth weight. These are good reasons to celebrate the recent coverage gains among women.

  • Another high-stakes challenge to the ACA is headed to the Supreme Court, and this time it’s a question of statutory interpretation: does the law as written permit tax credits to be issued in states that aren’t running their own exchanges? At risk is affordable coverage in as many as 34 states where millions of exchange shoppers may have to decide whether to pay the full, unsubsidized premiums or go uncovered. 

  • On November 1, ACA marketplace open enrollment begins for 2018. Given the political turmoil around the ACA this year, consumers who depend on the marketplaces for coverage are likely wondering what to expect come November 1. This webinar helped consumers and reporters unpack what is known and still unknown about the individual market.

  • Since last fall, 25 states and the District of Columbia have been enrolling millions of newly eligible persons in Medicaid under the ACA's expansion provisions. The other 25 states have opted not to expand eligibility at this time. A handful of states are pursuing other expansion options, such as premium assistance models.

  • In this essay, two former state Medicaid directors examine the Medicaid expansion from different stakeholder perspectives and offer evidence of the sustained financial benefits that can accrue to states accepting federal funding to expand Medicaid eligibility.

  • Reference pricing, tiered provider networks and narrow networks—three benefit design strategies gaining favor among employers and health plans trying to slow cost growth. While these designs aim to encourage value-informed consumer choices, some perceive them as overly restrictive.

  • David Philipps and Michael Ciaglo have been awarded an Honorable Mention for the 20th Annual Health Care Print Journalism Award in the General Circulation category for their Colorado Springs Gazette series, “Other than Honorable.” This investigation identifies a surge in soldiers, including wounded combat veterans, being discharged from service for misconduct—often losing health benefits—in an apparent downsizing.

  • This webinar, co-hosted by NIHCM Foundation and the Association of Maternal and Child Health Programs with support from the Maternal and Child Health Bureau, explored ways to connect women to dental coverage and care during pregnancy, including the impact of the ACA on dental insurance options; strategies to integrate dental screenings and referrals into prenatal care; and efforts to educate pregnant women on dental care.

  • Half of U.S. health spending goes to care for just 5 percent of patients, and any effort to improve the efficiency of our health care dollars must prioritize these patients. Speakers discussed coverage and care for the high-cost, high-need population.

  • As we approach the ACA's third open enrollment, health insurance is still far from universal for some minority groups. One in five Hispanics were uninsured last year. And although coverage rates among African Americans have surged nationally, success has varied from state to state based on Medicaid expansion decisions and other factors.

  • The number of consumers in the individual health insurance market is expected to double by 2019. Many of the new consumers will be health insurance novices facing a daunting array of decisions. In light of these changes, innovative insurers are increasingly viewing retail stores as a consumer-friendly way to facilitate purchasing and encourage proactive health care choices.

  • This essay takes a look at developments in the small group market since the passage of the ACA and highlights several issues that could threaten the long-term viability of this market as implementation moves forward.

  • The ACA open enrollment for 2018 has begun amid consumer confusion and concerns about future market stability, but much can be done to put the individual market on a sustainable path. This webinar provided analysis of individual market dynamics as well as potential stabilization strategies.

  • In this essay, Joel Ario explains Section 1332 waivers and lays out ways states could use this mechanism to put their own stamp on health reform.

  • In this essay, Alice Rosenblatt explains how actuaries set premiums, shows how key provisions of the ACA will affect their pricing for the October 2013 open enrollment period and describes what’s at stake if they don’t get it right.

  • Laura Dague has been awarded the 21st Annual Health Care Research Award for her paper “The Effect of Medicaid Premiums on Enrollment: A Regression Discontinuity Approach” published in the Journal of Health Economics, May 2014. This paper demonstrates that adopting even a small monthly premium of $10 in Medicaid can cause low-income families to drop out of the program.

  • The potential effects of the ACA’s new premium tax credits and employer penalties on the group market are hotly debated, but relentless increases in health care costs have already begun to drive change.

  • Twelve journalists from across the U.S. have been selected for the 2015 class of the Health Coverage Fellowship. The 2015 fellows are from WBUR-Radio in Boston, Mississippi Public Broadcasting, POLITICO, The Boston Globe, the Portland (ME) Press Herald, the Los Angeles Times, Kaiser Health News, The Washington Post, Hearst Connecticut Media Group, New Hampshire Public Radio, the Worcester Telegram & Gazette, and National Public Radio.

  • This NIHCM-funded study used data from the Massachusetts Group Insurance Commission to investigate whether patient choice of physician under tiered networks varies according to demographic characteristics, health status, physician specialty or type of care being sought. Results are expected to inform the design of tiered networks so they are most effective at directing patients to high-value providers.

  • In this Expert Voices essay, former CMS actuary John Bertko outlines the complex factors plans are weighing as they develop their 2015 premiums, noting the uncertain impact of many of these factors. 

  • This webinar brought together top thought-leaders to discuss health care's ongoing challenges, including what to expect from Congress, the Trump Administration and the states in the coming months.