On June 21, the Institute of Medicine (IOM) released a report, suggesting that federal and state governments review and revise public health laws to ensure that they adequately address the current health care landscape.  Created at the request of the Robert Wood Johnson Foundation (RWJF) and presenting the findings of a committee of experts, the report also stresses the importance of evaluating the effects of non-health care legislation, noting that such legislation can have a significant impact on public health.  Finally, the report recommends that states require health agencies to require 10 essential public health services.

From the report:

On June 29, Families USA released a report examining Medicaid cuts outlined under U.S. Rep. Paul Ryan’s (R-WI) $3.5 trillion FY2012 budget proposal, approved by the U.S. House on April 15.  In addition to repealing most provisions of the national health care reform law, the budget would also convert Medicaid into a block grant program beginning in 2013, reducing state payments by 5 percent in 2013, 15 percent in 2014, and 33 percent in 2021.  Based on an economic modeling tool used by the U.S. Department of Commerce to assess the impact of major events on regional economies, Families USA’s analysis finds that the Medicaid cuts would risk a total of 35,210 jobs and $4.2 billion in economic activity.  The report estimates that the cuts would harm program enrollees, reduce business activity, and contribute to job losses.  The report also provides state-level estimates of the impact of each cut on business activity and jobs.

From the report:

Health Affairs has released a study finding that hospitals in areas with robust hospital competition tend to address shortfalls between Medicare payments and projected costs primarily by reducing hospital costs.  Conversely, the authors found that hospitals in areas where hospital care is concentrated among a limited number of providers respond by raising the prices they charge private insurers, in a practice known as “cost shifting”.  The authors argue that their findings necessitate a policy discussion about whether increased provider integration will interfere with the national health care reform law’s goal of reducing Medicare spending, as increased integration could reduce market competition and, in turn, increase the use of cost shifting.

Robinson, James. (2011). Hospitals respond to Medicare payment shortfalls by both shifting costs and cutting them, based on market concentration. Health Affairs, 30 (7): 1265-1271. doi: 10.1377/hlthaff.2011.0220. http://content.healthaffairs.org/content/30/7/1265.abstract

Author: James Robinson.

The National Association of State Mental Health Program Directors has released a presentation examining care integrationg efforts for individuals with serious mental illnesses (SMIs) in Missouri.  The presentation outlines the state's activities under the initiative and highlights care integration and cost savings achieved as a result of those efforts.  The authors assert that Missouri serves as a model for other states to follow.

From the report:

The webinar focused on Missouri’s initiative to integrate behavioral health and primary care, including the state’s application for a health home state plan amendment under Section 2703 of the Affordable Care Act.  Dr. Joe Parks, with Missouri’s Department of Mental Health, gave an overview of the state’s health home initiative highlighting their definition of health homes, services implemented, outcomes achieved such as cost savings, and recommendations for integrating health care. 

Full report: Missouri’s Efforts to Integrate Care for Individuals with Serious Mental Illness: A Catalyst for Other States (PDF | 10.61 MB)

National Association of State Mental Health Program Directors.  (2011).  Missouri's efforts to integrate care for individuals with serious mental illness: a catalyst for other states.  Parks, J.

The Kaiser Family Foundation (KFF) has released a brief examining states’ progress towards implementing the health insurance exchanges required under national health care reform.  The brief examines challenges states face and summarizes early trends in exchange governance, structure, and financing.  The U.S. Department of Health and Human Services (HHS) recently issued regulations giving states until January 1, 2013 to demonstrate their ability to operate a functional exchange.  To date, more than a third of states have begun working towards implementation.  Required in every state by January 1 2014, HHS will operate exchanges in states that are unprepared or unwilling to operate their own.

From the report:

State-based health insurance exchanges are a key component of the Patient Protection and Affordable Care Act (ACA) of 2010, facilitating expanded access to coverage for millions of individuals and employees of small businesses. The health insurance exchanges, scheduled to be operational by January 2014, are intended to enable consumers to readily compare qualified health insurance options in order to select plans that best meet their needs. They will also be the mechanism through which low and moderate-income individuals receive premium and cost-sharing subsidies to make health coverage more affordable. The ACA allows states great latitude in how they design their exchanges, giving them flexibility over such things as how the exchange is structured, how it is governed, and how it certifies and contracts with health plans. If a state chooses not to create its own exchange, the federal government will operate one in the state. By 2019, the Congressional Budget Office estimates that over 24 million people will enroll in a health plan purchased through an exchange.

Full report: Establishing Health Insurance Exchanges: An Update on State Efforts (PDF | 394.49 KB)

Kaiser Family Foundation.  (2011).  Establishing health insurace exchanges: an update on state efforts.  

Health Affairs has published a study examining 17 states' patient-centered medical home initiatives.  The authors suggest that early findings indicate that the programs have been generally successful, resulting in improve care quality and cost trends.  The report also asserts that the initiatives have improved access to health services. 

Takach, M.  (2011).  Reinventing Medicaid: state innovations to qualify and pay for patient-centered medical homes show promising results.  Health Affairs, 30 (7): 1325-1334.  doi: 10.1377/hlthaff.2011.0170.  http://content.healthaffairs.org/content/30/7/1325.abstract

Author: Mary Takach