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Higher Costs, Lest Trust 

Patients who have high medical cost burdens have less faith in their physician's medical decision-making and more negative assessments of the quality of care they receive, according to a Commonwealth Fund–supported study in the Journal of General Internal Medicine. Researcher Peter Cunningham, Ph.D., a senior fellow at the Center for Studying Health System Change, says patients with high medical costs may believe that their doctors are more interested in financial gain than in providing appropriate and necessary services. Strengthening the patient–physician relationship through a medical home may help improve patient trust, he says.

Broad Support for Comprehensive Health Reform 

Leaders in health care and health care policy strongly support an ambitious health care reform agenda that expands coverage, improves quality and efficiency, and controls costs. In fact, two-thirds of those surveyed in a Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey in January said that the Obama administration should pursue these goals simultaneously. Investment in health information technology and access to public health insurance coverage for the long-term unemployed were among the reforms seen as crucial. See commentaries on the survey findings by Montana Senator Max Baucus and Minnesota Governor Tim Pawlenty.

Promoting Health IT: What the Feds Can Do

The federal government can do a lot to help health care providers overcome the financial, technical, and logistical obstacles to the adoption of health information technology, says David Blumenthal, M.D., one of the nation’s top experts in health IT. In an online article written for the Fund’s “Perspectives on Health Reform” series, Blumenthal, who directs the Institute for Health Policy at Massachusetts General Hospital/Partners HealthCare System, discusses a range of policy options--from assisting financially strapped providers with IT acquisition, to reforming the provider payment system, to creating national regulations and standards for data security and patient privacy.

Coordination Key for Special Needs Plans

Special Needs Plans (SNPs) are intended to improve care coordination, improve quality of care, and reduce the costs for treating high-risk, high-cost Medicare beneficiaries, including those who qualify for both Medicare and Medicaid benefits. Many SNPs, however, do not coordinate their benefits with state Medicaid programs, according to a Commonwealth Fund–supported study in Health Affairs. Lead investigator David C. Grabowski, Ph.D., of Harvard Medical School says that this, combined with negative perceptions of managed care among some of the elderly, has led to low plan enrollment and limited impact. Although a relatively small population, so-called dual-eligibles account for roughly 24 percent of Medicare spending and 42 percent of Medicaid spending, owing to their poor health and complex health care needs.

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