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Small Firm Self-Insurance Under the Affordable Care Act

November 28, 2012 - The Affordable Care Act changes the small-group insurance market substantially beginning in 2014, but most changes do not apply to self-insured plans. This exemption provides an opening for small employers with healthier workers to avoid broader sharing of health care risk. The authors of this brief conclude that regulation of stop-loss or reinsurance can prevent such adverse selection and increase stability in small-group insurance coverage.

Issue Brief

International Profiles of Health Care Systems: Australia, Canada, Denmark, England, France, Germany, Japan, Iceland, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States

November 19, 2012 - Read overviews of the health care systems of 15 countries—Australia, Canada, Denmark, England, France, Germany, Japan, Iceland, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States.

Fund Report

High-Performance Health Care for Vulnerable Populations: A Policy Framework for Promoting Accountable Care in Medicaid

November 16, 2012 - This report explores how state Medicaid agencies might align with and build on the Medicare Shared Savings Program, which rewards groups of providers that meet cost and quality benchmarks by working together to coordinate patients' care in accountable care organizations.

Fund Report

A Survey of Primary Care Doctors in Ten Countries Shows Progress in Use of Health Information Technology, Less in Other Areas

November 15, 2012 - More than two-thirds of U.S. primary care physicians were using electronic medical records in 2012, a substantial increase from 2009, when less than half had adopted the technology, a new Commonwealth Fund survey finds. But results also depict the U.S. as an outlier when it comes to affordability of health care.

In the Literature

University of California, San Francisco Medical Center: Reducing Readmissions Through Heart Failure Care Management

November 14, 2012 - In 2008, the University of California, San Francisco (UCSF) Medical Center embarked on a grant-funded program to reduce hospital readmissions for elderly patients with heart failure. This case study examines the factors that contributed to its success.

Case Study

Off the Hamster Wheel? Qualitative Evaluation of a Payment-Linked Patient-Centered Medical Home (PCMH) Pilot

November 13, 2012 - While there is broad agreement on the general concepts defining patient-centered medical homes, little is known about physician practices' on-the-ground experiences. In this Commonwealth Fund–supported study, researchers examined five practices engaged in efforts to become medical homes. All five practices received a risk-adjusted base payment per patient per month to support their efforts.

In Brief

The Influence of Hospice Use on Nursing Home and Hospital Use in Assisted Living Among Dual-Eligible Enrollees

November 13, 2012 - In this study, Commonwealth Fund–supported researchers examined over 12 months the outcomes of assisted living residents who are dually eligible for Medicare and Medicaid, seeking to determine the association of hospice use with nursing home and hospital admission.

In Brief

Interpretations of Integration in Early Accountable Care Organizations

November 13, 2012 - In this qualitative study, supported by The Commonwealth Fund, researchers interviewed 114 physicians and managers in four nascent accountable care organizations (ACOs), conducted site visits, and reviewed documents to explore how those forming ACOs envision integration with other provider groups.

In Brief

Insights from Transformations Under Way at Four Brookings–Dartmouth Accountable Care Organization Pilot Sites

November 6, 2012 - This study in Health Affairs examines the experiences of four early adopters of the accountable care organization (ACO) model.

In the Literature

Physicians with the Least Experience Have Higher Cost Profiles Than Do Physicians with the Most Experience

November 5, 2012 - With Commonwealth Fund support, the authors of this paper analyzed the cost profiles of physicians in Massachusetts to ascertain whether some physician types are more costly than others.

In Brief

A Framework for Evaluating the Formation, Implementation, and Performance of Accountable Care Organizations

November 5, 2012 - In their Commonwealth Fund–supported study, Dartmouth researchers analyzed early tracking data to identify the factors affecting ACOs' development and success and then proposed a model for structuring an evaluation framework for these new health care organizations.

In Brief

About Half of the States Are Implementing Patient-Centered Medical Homes for Their Medicaid Populations

November 5, 2012 - Half of state Medicaid programs are taking new approaches to provider payment—focusing on chronically ill populations, using shared teams, aligning payments with national quality standards, and implementing shared-savings programs—to help primary care practices become patient-centered medical homes for their low-income patients.

In the Literature

Can Sustainable Hospitals Help Bend the Health Care Cost Curve?

November 2, 2012 - Can the nation's hospitals "go green" and save money in the process? According to a new study, the adoption of a range of environmentally sustainable policies by the health care sector could yield in excess of $5.4 billion in savings over five years, and $15 billion over a decade.

Issue Brief

Jobs Without Benefits: The Health Insurance Crisis Faced by Small Businesses and Their Workers

November 1, 2012 - A new Commonwealth Fund study highlights a nearly decade-long trend of declining health insurance coverage and rising costs for workers in small businesses, particularly employees making less than $15 an hour.

Issue Brief

Despite the Recession's Effects on Incomes and Jobs, the Share of People with High Medical Costs Was Mostly Unchanged

October 24, 2012 - Almost one in five Americans younger than 65 lived in families with high medical costs in 2009, roughly the same as 2006 despite widespread job and health insurance losses and declining incomes, according to a Commonwealth Fund-supported study by the Center for Studying Health System Change published by Health Affairs.

In the Literature