Although primary care is fundamental to health system performance, the United States has undervalued and underinvested in primary care for decades. A new issue brief describes how the Affordable Care Act will begin to strengthen America's primary care system through: temporary increases in Medicare and Medicaid payments to primary care providers; support for innovation in the delivery of care, with an emphasis on achieving better health outcomes and patient experiences; enhanced support of primary care providers; and investment in the primary care workforce.
In a related blog post, Melinda Abrams, director of the Commonwealth Fund's Patient-Centered Coordinated Care program, provides estimates of how the new law is likely to benefit patients, providers, and payers.
Federal health reform will bring opportunities and challenges to the states, which are tasked with implementing and sustaining many of its provisions. A new report from The Commonwealth Fund and the National Academy for State Health Policy examines Affordable Care Act provisions that support states' health system improvement goals and profiles efforts in 10 states: Colorado, Kansas, Maine, Massachusetts, Minnesota, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington.
In this time of heightened concern about financial risk, many nonprofits and foundations have assigned greater responsibility to their staff and their board's audit committee to undertake regular, thorough reassessments of potential risks. The aim is to develop countermeasures to control risk and prevent, or at least reduce, the harm caused by negative events. In the Commonwealth Fund's 2010 Treasurer's Report, Executive Vice President and COO/Treasurer John E. Craig, Jr., discusses how The Commonwealth Fund has been able to improve its capacity to assess risk and identify areas requiring special attention.
This case study looks at the Rhode Island Quality Institute, which has guided the state toward notable improvements in reducing hospital-acquired infections and costs, establishing statewide capacity to fill electronic prescriptions, and adopting electronic health records.
A new issue brief looks at an effort in Rhode Island to use the nursing home regulatory process to promote resident-centered care. The Individualized Care Pilot enhanced the annual nursing home survey and incorporated site visits from the state Quality Improvement Organization. Based on reports from participating homes, the pilot helped nursing home administrators understand and implement resident-centered care.
A recent study in Germany found that patients enrolled in a diabetes management program had significantly lower mortality rates than those receiving routine care for their condition. Program participants also had fewer complications and hospitalizations and significantly reduced costs, the Commonwealth Fund–supported study found.
This study, supported by The Commonwealth Fund, found that in Massachusetts, where patient experience survey results are publicly reported, the majority of physician groups have initiatives to improve patient experience, such as changing office workflow, training staff, and investing in electronic health records.
A recent Commonwealth Fund–supported study found that certain characteristics of nursing homes—especially having advance directives in place or a higher number of registered nurses—were associated with fewer hospitalizations of residents. This suggests that payment incentives directed at reducing acute hospitalizations may be effective.
Another study drew lessons from nine evaluations of patient-centered medical homes; researchers concluded that such evaluations need to include both quantitative and qualitative analyses and focus on how physician and staff roles evolve, among other factors.
A third study looked at how "moral hazard"—the theory that people behave differently when they are insulated from risk—affects estimates of the numbers of underinsured, or those with high medical out-of-pocket costs relatives to their income.
A webinar held this week focused on how the Affordable Care Act will help ensure that baby boomers who lose employer health benefits—whether as a result of a layoff or early retirement—have ready access to affordable and comprehensive insurance. The event was cosponsored by The Commonwealth Fund, AARP, and Women in Government and featured Richard G. Frank, Ph.D., deputy assistant secretary for disability, aging, and long-term care policy in the U.S. Department of Health and Human Services; John Rother, J.D., executive vice president of policy, strategy, and international affairs at the AARP; Sara R. Collins, Ph.D., vice president for the Affordable Health Insurance program at The Commonwealth Fund; and Michelle M. Doty, Ph.D., assistant vice president and director of survey research at The Commonwealth Fund. View the webinar slides and recording and a related blog post.
Sara Collins, vice president for the Affordable Health Insurance program at The Commonwealth Fund, discusses the recently issued regulation on the review of "unreasonable" increases in health insurance premiums in a blog post. "This proposed regulation, along with the newly issued regulations limiting what percent of premiums insurance carriers can spend on non-medical services, will provide consumers with information about the increases they experience in their premiums each year and how their premium dollars are spent," she writes. "Such transparency is unprecedented in the individual and small group insurance markets and will create a new competitive dynamic and incentives to lower costs among carriers."
A number of quality improvement strategies in the federal health reform law, such as the promotion of patient-centered medical homes, depend on actively engaged patients. But navigating a complex and often uncoordinated health care system can be a formidable task, especially for patients with multiple conditions. The latest issue of Quality Matters describes several programs that use innovative assessment and self-management tools to help patients gain the information and knowledge necessary for effective self-care.
The Commonwealth Fund/Harvard University Fellowships in Minority Health Policy are now open to applicants for the 2011–12 fellowship year. This unique fellowship is designed to prepare physicians for leadership roles in formulating and promoting health policies and practices that improve access to high-quality care for minority and other disadvantaged populations. For more information, please visit http://www.mfdp.med.harvard.edu/fellows_faculty/cfhuf/about.html.
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The mission of The Commonwealth Fund is to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.