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Newsletter Article


Recent Commonwealth Fund reports and Fund-supported studies in the professional literature

Separate and Unequal: Racial Segregation and Disparities in Quality Across U.S. Nursing Homes. D. B. Smith, Z. Feng, M. L. Fennell et al. Health Affairs, Sept./Oct. 2007. In metropolitan areas across the U.S., blacks are more likely than whites to live in poor-quality nursing homes. The disparity appears to be linked to patterns of residential segregation.

Rewarding Excellence and Efficiency in Medicare Payments. K. Davis and S. Guterman. Milbank Quarterly, September 2007. A new, blended Medicare payment strategy that combines fee-for-service payments with payments based on episodes of care would create incentives for providers to deliver both high-quality and efficient care.

Medicare Prescription Drug Benefit Progess Report: Findings From a 2006 National Survey of Seniors. P. Neuman, M. K. Strollo, S. Guterman et al. Health Affairs Web Exclusive, August 21, 2007. The majority of seniors who lacked drug coverage in 2005—before the establishment of the Part D Medicare prescription drug benefit—obtained it in 2006. However, even with Part D coverage, many seniors reported relatively high out-of-pocket spending in 2006.

Medicare Prescription Drug Benefit Progress Report: Chartpack. Kaiser Family Foundation, The Commonwealth Fund, Tufts–New England Medical Center. August 2007. Findings from the Kaiser/Commonwealth/Tufts-New England Medical Center 2006 National Survey of Seniors and Prescription Drugs.

Value-Driven Health Care Purchasing: Four States that Are Ahead of the Curve. S. Silow-Carroll and T. Alteras. August 2007. Several states are pursuing value-based purchasing initiatives that emphasize collection of quality-of-care data, transparency of quality and cost information, and incentives. This overview report of public–private efforts finds that tiered premiums, pay-for-performance measures, and the designation of high-performance providers as "centers of excellence" are paying off. Individual case studies (see below) dig deeper.

Value-Driven Health Care Purchasing: Case Study of the Massachusetts Group Insurance Commission. S. Silow-Carroll and T. Alteras. August 2007. A case study of the Massachusetts Group Insurance Commission, the state's largest purchaser of health care after Medicaid, covering more than 267,000 state employees, retirees, and their dependents.

Value-Driven Health Care Purchasing: Case Study of Minnesota's Smart Buy Alliance. S. Silow-Carroll and T. Alteras. August 2007. A case study of the Smart Buy Alliance, a group of public and private health care purchasers in Minnesota working together in hopes of driving greater quality and value in the market.

Value-Driven Health Care Purchasing: Case Study of Washington State's Puget Sound Health Alliance. S. Silow-Carroll and T. Alteras. August 2007. A case study of the Puget Sound Health Alliance in Washington, which seeks to improve the quality of health care by using guidelines for evidence-based medicine to develop performance reports and aligning incentives in purchasing and consumer decision-making.

Value-Driven Health Care Purchasing: Case Study of Wisconsin's Department of Employee Trust Funds. S. Silow-Carroll and T. Alteras. August 2007. A case study of the Wisconsin Department of Employee Trust Funds, the largest purchaser of employer coverage in the state.

Lessons from Local Access Initiatives: Contributions and Challenges. K. Minyard, D. Chollet, L. Felland et al. August 2007. This report offers five case studies of community health initiatives—locally crafted responses to health care access problems that have been steadfast in their efforts to connect uninsured and medically indigent people to health care services and health insurance.

Reauthorizing SCHIP: Opportunities for Promoting Effective Health Coverage and High-Quality Care for Children and Adolescents. L. Simpson, G. Fairbrother, S. Hale, and C. Homer. August 2007. Reauthorization of the State Children's Health Insurance Program (SCHIP) presents an opportunity to build on the gains already achieved by the program. This report presents a framework for promoting effective health coverage and achieving high quality in SCHIP and Medicaid.

Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help. S. R. Collins, C. Schoen, J. L. Kriss, M. M. Doty, and B. Mahato. August 2007. The proportion of young adults lacking health insurance is one of the highest of any demographic group in the U.S. population. This completely updated and revised report discusses how some states are tackling the problem and presents additional policy changes that could help uninsured young adults gain coverage and keep it.

Measuring and Reducing Waiting Times: A Cross-National Comparison of Strategies. S. Willcox, M. Seddon, S. Dunn et al. Health Affairs, July/August 2007. Former Commonwealth Fund Harkness Fellows in Health Care Policy examine waiting time strategies used in Australia, Canada, New Zealand, and the U.K.

The Inverse Relationship Between Mortality Rates and Performance in the Hospital Quality Alliance Measures. A. K. Jha, E. J. Orav, Z. Li, and A. M. Epstein. Health Affairs, July/August 2007. Researchers examined the relationship between hospitals' performance on Hospital Quality Alliance indicators and mortality rates, and found that if the lowest-performing U.S. hospitals performed as well as top-performers on specific quality measures, 2,200 fewer Americans would die each year.

Health Care Opinion Leaders' Views on the Quality and Safety of Health Care in the United States. K. K. Shea, A. Shih, and K. Davis. July 2007. In a survey of leading health care experts, the top strategies for improving the quality and safety of U.S. health care include greater government leadership, the creation of a new public–private entity to coordinate quality improvement efforts and set a national quality agenda, and reforming the way providers are paid.

An Analysis of Leading Congressional Health Care Bills, 2005–2007: Part II, Quality and Efficiency. K. Davis, S. R. Collins, and J. L. Kriss. July 2007. This report reviews the major House and Senate bills introduced between 2005 and 2007 to advance the quality and efficiency of the health system.

The Commonwealth Fund/National Opinion Research Center Survey of Retiree Health Benefits, 2005: A Chartbook. H. Whitmore, J. Pickreign, and J. R. Gabel. July 2007. A chartbook from The Commonwealth Fund and the National Opinion Research Center offers a window into the state of retiree health benefits in the U.S.

Measuring Hospital Performance: The Importance of Process Measures. A. Shih and S. C. Schoenbaum. July 2007. Recent debate has focused on the relationship between performance on Hospital Quality Alliance (HQA) process measures and short-term mortality. The authors of this data brief contend that HQA measures represent actionable items that can have an impact on quality and health outcomes.

Denver Health: A High-Performance Public Health Care System. R. Nuzum, D. McCarthy, A. Gauthier, and C. Beck. July 2007. Case study of Denver Health, a comprehensive and integrated medical system that is Colorado's largest health care safety-net provider.

Use of Health Services by Previously Uninsured Medicare Beneficiaries. J. M. McWilliams, E. Meara, and A. M. Zaslavsky. New England Journal of Medicine, July 12, 2007. In a study comparing health care use and expenditures of adults who did and did not have insurance prior to enrolling in Medicare, researchers found that the previously uninsured had significantly more physician visits and hospitalizations than did adults who had coverage.

Lost Opportunities: Physicians' Reasons and Disparities in Breast Cancer Treatment. N. A. Bickell, F. LePar, J. J. Wang et al. Journal of Clinical Oncology, June 20, 2007. Many women do no receive adjuvant therapies shown to decrease mortality and morbidity from breast cancer because of "system failures"—breakdowns that occur despite surgeons' recommendation for treatment and patients' willingness to receive it.

Resident Outcomes in Small-House Nursing Homes: A Longitudinal Evaluation of the Initial Green House Program. R. A. Kane, T. Y. Lum, L. J. Cutler et al. Journal of the American Geriatrics Society, June 2007. Residents of innovative Green House nursing homes were found to experience better quality of life, with the same or better quality of care than those in traditional nursing facilities.

Medicare's Quality Improvement Organization Program Value in Nursing Homes. A. Shih, D. M. Dewar, and T. Hartman. Health Care Financing Review, Spring 2007. Quality Improvement Organizations (QIOs) work with the Centers for Medicare and Medicaid Services to improve the quality of care that Medicare beneficiaries receive. A new study suggests the QIO program for nursing home care is a sound investment of federal dollars.

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