The Commonwealth Fund Connection

The Commonwealth Fund Connection is a roundup of recent Fund publications, charts, multimedia, and other timely content. 

  • October 8, 2010 Issue
Setting Up Health Insurance Exchanges: How to Overcome Eight Difficult Issues

A new Commonwealth Fund report offers recommendations for state and federal policymakers as they design and implement health insurance exchanges, which are a key element of the Affordable Care Act. The state-based exchanges, to be set up by states and the federal government to provide a health insurance marketplace with subsidized health insurance for small businesses and individuals without employer or public coverage, will play a major role in enhancing Americans' access to health insurance coverage when they are fully implemented in 2014.

The report by Timothy Stoltzfus Jost, professor of law at the Washington and Lee University School of Law, examines issues that policymakers will grapple with as they work to implement the exchanges and provides detailed recommendations to improve affordability and access to coverage purchased through the exchanges. These include how exchanges should be set up and governed; how they can avoid adverse selection—or having a disproportionately large share of high-cost enrollees, leading to unaffordable premiums within the exchange—and how to reduce administrative costs. Also see Jost's blog on overcoming barriers to implementing health insurance exchanges.

Join a Nov. 4 webinar on health insurance exchanges with Jost, Michael T. McRaith, director of the Illinois Department of Insurance, and Sara R. Collins, vice president of the Affordable Health Insurance Program at The Commonwealth Fund. Click here to learn more or register.

Realizing Health Reform's Potential: Young Adults and the Affordable Care Act
A new Commonwealth Fund issue brief—the latest in a series exploring how health reform will benefit different groups, as well as improve insurance coverage and change the delivery of care—focuses on young adults. The Affordable Care Act includes several short- and long-term provisions that promise to stem the rising tide of uninsured young adults. Of the 14.8 million uninsured young adults, up to 12.1 million may gain subsidized insurance once all the law's provisions go into effect in 2014: 7.2 million may gain coverage under Medicaid and 4.9 million may gain subsidized private coverage through the insurance exchanges. In addition, about 1 million uninsured young adults are expected to join their parents' policies over the next three years.
What Changes in Survival Rates Tell Us About U.S. Health Care
The United States continues to lag behind other nations when it comes to gains in life expectancy, and commonly cited causes for our poor performance—obesity, smoking, traffic fatalities, and homicide—are not to blame, according to a Commonwealth Fund-supported study published as a Health Affairs Web First.
Pre-Existing Condition Insurance Plans
The Affordable Care Act includes a provision for the establishment of temporary high-risk pools, also called Pre-Existing Condition Insurance Plans (PCIPs), to quickly make health insurance available to uninsured individuals with preexisting conditions, many of whom previously had been denied coverage. This issue brief examines eligibility, benefits, premiums, cost-sharing, and oversight of the PCIP programs, as well as variation of the plans from state to state. Visit the Fund's site to view slides and the recording of an Oct. 7 webinar on Pre-Existing Condition Insurance Plans.
Seeking Clinicians' Insights to Develop Measures of Patient Safety
In this Commonwealth Fund–supported study, Robert S. Rogers of Massachusetts General Hospital and colleagues sought to develop a process for identifying clinically meaningful measures of patient safety, drawing on the experiences of practicing providers.
What Is Integrated Patient Care?
In health care, the term "integration" can take on a number of meanings. It can apply to organizations such as integrated delivery systems or to formal collaborations among providers within or across institutions. In this Commonwealth Fund–supported study, Sara J. Singer of the Harvard School of Public Health and colleagues propose a definition of integrated patient care and develop a framework for measuring it.
Proposed Measures of Patient-Centered Medical Homes
As the number of medical homes multiply, it will be increasingly important to have standard benchmarks to evaluate their efficiency and cost-effectiveness, according to Meredith B. Rosenthal of the Harvard School of Public Health and colleagues in this Commonwealth Fund–supported study. Because medical homes will alter patterns of patient care, the authors propose measures for evaluating them based on use of health care services and costs.
Comparing Heart Failure Management Programs
In this Commonwealth Fund–supported study, Barbara Riegel of the University of Pennsylvania School of Nursing and other researchers developed and tested a tool to compare relative intensity and complexity of various programs to manage heart failure, taking into account their frequency, duration, and number of interventions.
Health Care When Workers Need It Most
Although those who must stop working because of a disability receive Social Security Disability Insurance (SSDI), they do not become eligible for Medicare until after a 24-month waiting period. This Commonwealth Fund–supported study, by Gina A. Livermore of Mathematica Policy Research and colleagues, looks at the insurance status, health care access, and other characteristics of SSDI beneficiaries during the three years before and three years after entry into the program.
Effectiveness of Long-Term Care Ombudsman Programs
Long-term care ombudsman programs advocate for the health, safety, welfare, and rights of people in nursing homes and other residential facilities. This Commonwealth Fund–supported study, by Caroll L. Estes of the University of California, San Francisco, and colleagues examines factors associated with the effectiveness of local ombudsman programs in California and New York.
Lessons from Abroad for U.S. Health Care
Recent Commonwealth Fund–supported studies published in the professional literature offer lessons and models from other nations for the U.S. health care system. The articles focus on: nurses' views of hospital care in five nations; improving coronary heart disease care in the U.S. and U.K.; approaches in the U.K., Denmark, and the Netherlands to providing after-hours care; efforts in Canada to control drug spending; and Germany's "carrot and stick" approach to improving population health and encouraging efficiency.
Blog: A Call for Standardized Rehospitalization Measures
In a recent blog post, Anne-Marie J. Audet, M.D., M.Sc., vice president of The Commonwealth Fund's Program on Health System Improvement and Efficiency, argues that the lack of a standard approach to measuring rehospitalizations is no longer tenable. "Rehospitalizations are prevalent, harmful to patients, and costly," she writes. "More important, they are a symptom of our fragmented health care system, which is still working within silos. To move toward greater levels of care coordination, integration, and accountability, we must have standard measures to track progress. After all, what gets measured gets done."
Video: How Health Services Research Was Used in Health Reform
View the video of a panel at the June 2010 AcademyHealth Annual Research Meeting, "How Health Services Research Was Used in Health Care Reform." The panel was hosted by Commonwealth Fund President Karen Davis and featured the Fund's Cathy Schoen, Jonathan Gruber of the Massachusetts Institute of Technology, Mark McClellan of the Brookings Institution, Jack Ebeler of Health Policy Alternatives, and Elizabeth Fowler from the Senate Finance Committee.
New Health Reform Resource Center
The Commonwealth Fund recently launched the Health Reform Resource Center, the most comprehensive tool for exploring and understanding the provisions of the Affordable Care Act. Visitors to the Center can view a timeline of the law's major provisions and use the "Find Health Reform Provisions" tool to search for clear, detailed summaries of specific provisions by year, category, and/or stakeholder group. User Survey: Help Us Improve the Site
We invite you to take a short survey to tell us what you think of, The Commonwealth Fund's performance benchmarking and quality improvement site. We are working to expand and improve the site; your responses will help us make it as useful as possible.

Webinar: Care Coordination and Case Management for Children
Join an Oct. 12. webinar hosted by the Urban Institute and the National Academy for State Health Policy on opportunities in Medicaid and the Children's Health Insurance Program to provide care coordination and case management for children receiving intervention services. For more information and to register, visit
2010–11 Harkness Fellows
The Commonwealth Fund's Harkness Fellowships in Health Care Policy and Practice provide a unique opportunity for mid-career health services researchers and practitioners from Australia, Germany, the Netherlands, New Zealand, Norway, Switzerland, and the United Kingdom to spend up to 12 months in the United States, conducting original research and working with leading U.S. health policy experts. Read about the backgrounds and projects of the new Commonwealth Fund Harkness Fellows.
Request for Proposals
The Picker Institute has issued a Request for Proposals for its new "Always Event" Challenge Grant Program. The program will provide matching grants to support the development and implementation of innovative projects designed to demonstrate how the Always Events concept can be implemented in practice. Always Events are defined as "those aspects of the patient and family experience that should always occur when patients interact with health care professionals and the delivery system."

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