The Commonwealth Fund Connection

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

  • December 19, 2011 Issue
The Relationship Between Hospital Admission Rates and Rehospitalizations

Regions of the United States where discharged hospital patients are readmitted at comparatively high rates are often the same regions where overall hospitalization rates are high, new Commonwealth Fund–supported research finds. The study, published in the New England Journal of Medicine (Dec. 15, 2011), finds that the high use of hospital services in these areas is the factor most closely linked to rehospitalization rates, a strong indication of broad, systemic problems within U.S. health care.

The study, conducted by Arnold Epstein, M.D., Ashish Jha, M.D., and John Orav, Ph.D., examined rehospitalization rates across the country for Medicare patients with congestive heart failure and pneumonia, while also looking at how other variables, such as overall hospitalization rates, differences in patients' coexisting conditions, quality of discharge planning, and the number of hospital beds and physicians, affected readmissions. Of all the potential causes for regional differences in readmission rates, overall hospital admission rates played the biggest role, accounting for 16 percent to 24 percent of the variation in cases of congestive heart failure and 11 percent to 20 percent for pneumonia cases. No other factor accounted for more than 6 percent of the variation.

The Aftermath of the Super Committee: What Will It Take to Reduce Federal Health Spending?
At a December 2 Alliance for Health Reform briefing, cosponsored by The Commonwealth Fund, Kaiser Family Foundation, SCAN Foundation, and Robert Wood Johnson Foundation, a panel of experts discussed the potential implications for federal health policy of the failure of the Joint Select Committee on Deficit Reduction—known as the super committee—to reach agreement on how to reduce the federal deficit. In a new blog post, The Commonwealth Fund’s Caryn Marks, M.P.P., Megan Keenan, M.P.H., and Stuart Guterman summarize the panelists’ views on what will happen next and ways to reduce federal spending on health care programs.
Commonwealth Fund Articles in the Literature

Recent Commonwealth Fund–supported articles in the peer-reviewed literature examine:

In another article, 2008–09 Harkness Fellow in Health Care Policy and Practice Christopher Millet, Ph.D., M.Sc., M.Phil., and colleagues call for better measures to assess how well patients are protected from the financial consequences of illness (PloS Medicine, Sept. 2011). An article by 1998–99 Harkness Fellow Mary Seddon and colleagues describes a successful effort to reduce central line–associated bloodstream infections in one New Zealand institution (New Zealand Medical Journal, July 29, 2011).

In a recent analysis, Commonwealth Fund senior policy analyst Mark Zezza, Ph.D., and colleagues found similar variations in spending and inpatient admissions by both Blue Cross Blue Shield of Texas, the state’s largest health insurer, and Medicare (American Journal of Managed Care, Dec. 2011).

Final Regulation on Medical Loss Ratio Reporting and Rebates
The U.S. Department of Health and Human Services (HHS) recently issued final regulations governing the Affordable Care Act's medical loss ratio (MLR) requirements on the percentage of enrollees' premiums health plans spend on medical care versus administration and profits. In a blog post, The Commonwealth Fund's Sara R. Collins, Ph.D., and Tracy Garber present an analysis of the rule, which requires plans in the large-employer group market that spend less than 85 percent of their premiums on medical care and quality improvement activities, and plans in the small-employer group and individual markets that spend less than 80 percent on the same, to offer rebates to enrollees. HHS estimates that in 2012, up to 9 million people might be eligible for rebates worth from $600 million to $1.4 billion.
Controlling Costs Across International Health Systems
The Commonwealth Fund's 14th annual International Symposium on Health Care Policy, held last month, brought together health ministers and leading policy thinkers from across the industrialized world to explore ways of achieving a sustainable high-performing health care system. In a new blog post, Robin Osborn, M.B.A., vice president and director of The Commonwealth Fund's International Program in Health Policy and Innovation, reports on the symposium, where participants from Australia, Canada, France, Germany, New Zealand, the Netherlands, Norway, Sweden, Switzerland, the United Kingdom, and the United States examined approaches to such shared challenges as measuring and benchmarking outcomes and redesigning health care systems around the needs and preferences of patients.
Integrating Mobile Technology into Public Health Campaigns
In a new blog post, Harkness Fellows in Health Care Policy and Practice Robyn Whittaker, M.P.H., M.B.Ch.B. (2010–11), of the National Institute for Health Innovation, University of Auckland , and Hedda van't Land, Ph.D. (2009–10), of the Innovation Centre of Mental Health and Technology, Trimbos Institute , describe public health campaigns in their home countries, New Zealand and the Netherlands, respectively, that use texting and other mobile tools to reach targeted audiences. The programs may offer lessons for the United States, where recent policies are spurring interest in the use of health information technology to improve care.
Health Delivery System Reform: Lessons from States
A new AcademyHealth report examines the experience of eight states (Colorado, Kansas, Massachusetts, Minnesota, Ohio, Oregon, Vermont, and Washington) that pursued cost containment, quality improvement, and payment reforms as part of the State Quality Improvement Institute, led by AcademyHealth with support from The Commonwealth Fund. The report offers insight into what can make reform efforts successful at the state level, as well as barriers that can prevent progress. Interactive Map

Enhancements to the interactive map enable robust explorations of health system performance at the national, state, county, and regional levels. Using new map overlays, users can zoom in on communities involved in key delivery system reform efforts, such as the Beacon Communities or areas where patient-centered medical homes have taken hold, as well as flag health care providers that have been recognized for delivering high-quality care.

New performance data have also been added to the map, including:

  • health information technology measures tracking whether hospitals have adopted basic or comprehensive electronic medical record systems;
  • prevention quality indicators tracking hospital admissions by county for conditions such as diabetes and asthma;
  • inpatient quality indicators showing county rates for coronary artery bypass grafts and other procedures;
  • patient safety indictors showing county rates for bloodstream infections and other complications of hospital care;
  • population health measures by region assessing the number of Medicare beneficiaries with various conditions, such as heart failure; and
  • utilization and cost measures by region assessing standardized costs for imaging, lab tests, or emergency department visits among Medicare beneficiaries.
AHCJ Media Fellows Announced

The Association of Health Care Journalists (AHCJ) has named three veteran journalists to the second class of AHCJ Media Fellowships on Health Performance. The fellowship program, supported by The Commonwealth Fund, is intended to give mid-career print, broadcast, and online reporters an opportunity to learn about examples of high-performing health care systems, focus on innovations in care delivery, and explore a system or its significant parts to determine what makes that system effective or ineffective. Fellows are expected to complete significant and unique reporting projects by the end of 2012.

The 2012 fellows will be:

  • John George, a health care reporter for the Philadelphia Business Journal. George will focus on the state of obstetrics services in the Philadelphia area.
  • Margot Sanger-Katz, a health care correspondent for the National Journal in Washington, D.C. Sanger-Katz will examine the growing pattern of hospital consolidation and its influence on health care costs and the future of health reform.
  • Tammy Worth, a Kansas City–area freelance writer. Worth will produce articles about health care delivery to undocumented immigrants without health insurance.
Fellowship in Minority Health Policy Open to Applicants
The Commonwealth Fund/Harvard University Fellowship in Minority Health Policy is designed to prepare physicians for leadership roles in promoting health policies and practices that improve access to high-quality care for minority, disadvantaged, and vulnerable populations. The application deadline for the 2012–13 fellowship is January 3, 2012. For more information, please visit:
2012–13 Harkness Fellowships Open to Applicants

Applications for the 2012–13 Harkness Fellowships remain open to individuals from the Netherlands and Canada. The Commonwealth Fund's Harkness Fellowships in Health Care Policy and Practice provide a unique opportunity for mid-career professionals—academic researchers, government policymakers, clinicians, managers, and journalists—to spend up to 12 months in the United States conducting a policy-oriented research study.

Deadlines for receipt of applications are as follows:

  • The Netherlands: January 4, 2012.
  • Canada: February 14, 2012.

Note that the application process for Australia, Germany, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom is now closed.

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