Health Affairs

JUST RELEASED The September 2024 issue is now available! Read Editor in Chief Alan Weil's introduction to the new issue on Access To Care, Coverage & More. Explore the issue: https://bit.ly/3Xs9OGT

Honored to have my article on the Inflation Reduction Act with Richard Kane featured in the Health Affairs 2024 Elections Round-up. Lots of great articles here covering the most important issues at stake in our field.

In their new Forefront article, Eva H. Allen, Jennifer M. Haley, Tricia Brooks, Genevieve M. Kenney, Allexa Gardner of the Urban Institute and the Georgetown University McCourt School of Public Policy argue that no child should be disenrolled from, or not enrolled in, the coverage to which they are entitled due to faulty systems and incorrect procedures veiled by a lack of transparency into state operations and insufficient federal oversight. "We found that relatively few strategies were implemented with children specifically in mind. However, because children represent a large share of Medicaid enrollees, most strategies states used affected outcomes for children. We also found that state officials could not pinpoint a single policy or approach that had the greatest impact on reducing procedural disenrollment, but all asserted that a combination of approaches likely contributed to their success. This included greater reliance on automated or “ex parte” renewals (using available data, such as wage data, to assess and confirm ongoing eligibility without beneficiary action); the use of available flexibilities; multimodal, multitouch direct outreach to enrollees; community and managed care partnerships; and targeted communication campaigns." Read the full article here: https://bit.ly/4erwpJN

In their new Forefront article, Daniel Mont, Jennifer Madans, Nanette Goodman, Sophie Mitra, Zachary Morris, Ari Ne’eman, and David Wittenburg from the Center for Inclusive Policy (CIP), the Burton Blatt Institute, Fordham University, Suny At Stony Brook, the Harvard T.H. Chan School of Public Health, and Westat argue that the answer to improving disability data collection is not to retain the current ACS-6 but to adopt tested questions that use a scaled response and to expand disability data collection on other data collection platforms in a broad, participatory, and coordinated way. "The plan to shift from ACS-6 to WG-SS measures was motivated by the desire to move beyond simple yes-or-no questions and to better capture the varying degrees of difficulty that people experience in core functional areas such as seeing, hearing, walking, and remembering. Proponents argue that this shift could lead to more accurate and meaningful data, which is essential for crafting effective policies." Reaad the full article here: https://bit.ly/47LWwZs

In their new Forefront article, Stephen Blumberg and Amy Branum from the Centers for Disease Control and Prevention respond to a recent Forefront article by Landes et al., arguing that there is no universally endorsed standard for defining disability status. "The two question sets yield different estimates of the prevalence of disability in the United States, as has been well-documented by NCHS as well as by researchers in other publications. And some critics—including Scott Landes and colleagues, the authors of a recent Forefront article—have pointed to these differences as a sign that the WG-SS is “inadequate.” As applied by the NHIS, they wrote, the question set yields “artificially” low estimates of disability." Read the full article here: https://bit.ly/4gP2CMX

In anticipation of the 2024 presidential election, Health Affairs has been collecting articles we've published over the years to surface evidence and analysis on the health-related topics that are talking points on both sides of the aisle. Check out what we've collected!

Advancing Equity through Accountable Care. Join Dr. Purva Rawal of the CMS Innovation Center at our free virtual event on Thurs, Oct 17, 1pm-2pm ET. Topics will include data collection to support whole-person care and payment innovations. Register today: https://bit.ly/47RXbsf

In their new Forefront article, Tanya Shah and Luke Tobeler discuss how, ahead of upcoming federal alignment changes, states should work with their long-term care delivery system partners to explore how innovative linkages of existing policies and programs can be used as an incremental approach to growing enrollment in fully integrated arrangements for dually eligible beneficiaries with long-term care needs. "These changes build on the Medicaid and CHIP Payment and Access Commission’s (MACPAC’s) series of recommended strategies for states to use D-SNP contracts as tools to enhance Medicare-Medicaid integrated care (MMIC) for beneficiaries, as well as a piece in Health Affairs Forefront on how Medicare value-based care innovation models can enable better integration. Still, dually eligible beneficiaries must navigate a vast array of unaligned arrangements that exist in the government-sponsored health care system today." Read the full article here: https://bit.ly/3XJadnr

In their new Forefront article, H. Gilbert Welch and Barnett Kramer argue that, if the Centers for Medicare and Medicaid Services (CMS) cannot persuade GRAIL of the importance of randomization and using cancer death as the outcome, then it should cancel their Galleri-Medicare study. "The Galleri-Medicare study called REACH (Real-world Evidence to Advance Multi-Cancer Early Detection Health Equity) is a non-randomized, observational study of 50,000 Medicare beneficiaries. The intervention group will be recruited to receive the Galleri test. The control group will be a passively enrolled “Contemporaneous Comparator Arm” of beneficiaries in the general Medicare population who are not offered the test—and are not even aware they are in the study. The problem is that individuals volunteering to undergo screening are systematically healthier than those in the general population. In other words, sick patients with cancer (as well as heart disease and diabetes) are less likely to be in the intervention group than the control group." Read the full article here: https://bit.ly/3NaGEpK

In their new Forefront article, Purva Rawal, Doug Jacobs, Pauline Lapin, John Pilotte, Sarah Fogler, Ryan Howe, Meena Seshamani, and Elizabeth Fowler from the U.S. Department of Health and Human Services (HHS) discuss how recent proposed changes to the Medicare Shared Savings Program and the Medicare Physician Fee Schedule demonstrate how CMS intends to scale Innovation Center findings in the Medicare program. "The evidence supporting the benefits of primary care is clear: Access to high-quality advanced primary care is closely linked to better health outcomes, lower rates of mortality, and lower system spending, including reductions in emergency department, admissions, and inpatient use that may improve the affordability of health care services. However, improved primary care financing is necessary to drive growth in accountable care and transform care delivery that can improve quality and outcomes, and narrow health disparities. The 2021 National Academies of Sciences, Engineering, and Medicine’s (NASEM) report on the future of primary care called for hybrid payment approaches that provide partial fee-for-service and population-based payments, which Innovation Center models have also shown to support team-based care. Improved financing for primary care continues to be a focus for experts, including the recently established NASEM Standing Committee on Primary Care. Despite this strong evidence, approximately 45 percent of primary care practices are not in value-based programs or models that provide hybrid payment or supports to build advanced primary care. Reasons for this lag include the need for more support to providers to make this transition and the potential for predictable revenue from fee-for-service payments than that provided through value-based payment models that may have financial or performance-based risk." Read the full article here: https://bit.ly/4dEuKj7