Mathematica Policy Research has released a brief examining opportunities to improve dual eligibles' care through managed care plans in Medicare.  The authors offer background on dual eligibles and state efforts to manage their care.  The brief also examines opportunities for expanding managed care for dual eligibles under the national health care reform law.

From the report:

Only July 8, 2011, CMS announced three new initiatives to assist states in improving care for dual eligibles.  Two new financial models to support state efforts to coordinate care for dual eligibles.  A capitated model in which a state, CMS, and a health plan enter into a three-way contract, and the plan receives a prospective blended payment to provide comprehensive, coordinated care.  A managed fee-for-service model in which a state and CMS enter into an agreement that would permit the state to share in Medicare savings for care coordination initiatives.

Full report: Improving Care for Dual Eligibles: Opportunities for Medicare Managed Care Plans (PDF | 183.71 KB)

Mathematica Policy Research.  (2011).  Improving care for dual eligibles: opportunities for Medicare managed care plans.  Verdier, J.

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

The New England Journal of Medicine has published a study finding that Blue Cross and Blue Shield of Massachusetts’ (BCBS) global payment system, the Alternative Quality Contract (AQC), reduced costs in its first year of operation.  Beginning in 2009, BCBS began five-year AQCs with seven provider groups, which assumed spending accountability in return for the potential to receive quality and savings bonuses.  Examining claims data from 2006 to 2009 for participating provider groups and a control group of non-participating provider groups, the study found that costs did not increase as rapidly among participating organizations.  The authors found that savings were achieved through shifting outpatient care to facilities with lower fees, lowering expenditures for medical procedures, and lowering spending on enrollees with the highest expected spending.  In 2009, all participating groups met their budget targets and received savings bonuses.  However, the authors posit that future cost growth reduction under the AQC system will depend on budget targets and provider groups’ ability to further improve efficiency.

Song, Z., et. al.  (2011).  Health care spending and quality in year 1 of the alternative quality contract.  New England Journal of Medicine.  http://www.nejm.org/doi/full/10.1056/NEJMsa1101416#t=abstract

Authors: Zirui Song, Dana Gelb Safran, Bruce Landon, Yulei He, Randall Ellis, Robert Mechanic, Matthew Day and Michael Chernew. 

The Commonwealth Fund has released a survey of expert opinions regarding vulnerable populations in the U.S. health care system.  Nearly 70 percent of survey respondents reported believing the national health care reform law will improve health care access for vulnerable populations.  The authors also found that nearly 80 percent of respondents believed that the system is currently unsuccessful in providing equal health care access, quality, and outcomes for vulnerable populations.

From the report:

Virtually all leaders in health care and health care policy believe traditional safety-net institutions such as community health centers, public hospitals, and faith-based and mission-driven organizations will still fulfill critical roles in the U.S. health system after implementation of the Affordable Care Act, according to a Commonwealth Fund/ Modern Healthcare Health Care Opinion Leaders Survey. Nearly seven of 10 respondents believe the new law will effectively improve access and financial protection for vulnerable populations, and 70 percent support policies that would guarantee access to care for undocumented immigrants. Preferred strategies for improving the quality of care delivered by safety-net providers include ensuring access to enabling services, facilitating the adop­tion and spread of patient-centered medical homes, and moving toward tightly integrated models of care delivery. Approximately 80 percent feel the health system is currently unsuccessful in achieving equity across the specific domains of access, quality, and out­comes for vulnerable populations.

Full report: The Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey: Views Vulnerable Populations (PDF | 743.10 KB)

Commonwealth Fund.  (2011).  The Commonwealth Fund/Modern Healthcare health care opinion leaders survey: views vulnerable poplations.  Stremikis, K., Berenson, J., Shih, A. and Riley, P.

The Robert Wood Johnson Foundation has released a report examining the impact of electronic health records (EHRs) on health care quality.  The brief notes that doctors and hospitals serving Medicare patients must implement EHRs by 2015 or face a financial penalty.  Examining the care received by patients with diabetes at Better Health Greater Cleveland, the authors found those in practices employing EHRs provided all needed care to patients with diabetes at a statistically significantly higher rate that practices with paper records.

From the report:

Long Term Care and Dual Eligibles: Overview and Managed Care Opportunities

Health care is one of the last U.S. industries to universally incorporate technological advancements. While most sectors—from banking to hospitality—have made investments in information technology to improve efficiency and consumer relationships, America’s health care system is still largely paper-driven. Partly as a result, the U.S. health care system is plagued by inefficiency and poor quality. Delivery is slower, more error-prone and harder to measure and coordinate than it should be. One study found that 80 percent of medical errors began with miscommunication, incorrect or missing information about patients or lack of access to patient records.

Full report: Does Use of EHRs Help Improve Quality?  (PDF | 309.19 KB)

Robert Wood Johnson Founation.  (2011).  Does use of EHRs help improve quality?.  

On June 15, the Medicare Payment Advisory Commission (MedPAC) issued this report, offering recommendations for reforming Medicare’s payment system to improve quality and efficiency.  Among other recommendations, MedPAC suggests bundling payments for related health services and directly linking payments to health service quality.  The authors also offer recommendations for incentives to reduce excessive provision of health services under the current fee-for-service (FFS) reimbursement model.  Finally, MedPAC proposes improving dual eligibles’ care quality through more integrated and coordinated health services.

From the report:  

As part of its mandate from the Congress, each June the Commission reports on Medicare payment systems and on issues affecting the Medicare program, including changes in health care delivery and the market for health care services. In this report, we examine several issues within Medicare itself, including: 

• payments for physician services, with one chapter that considers alternatives to the sustainable growth rate (SGR) system and another on ways to improve payment accuracy and promote appropriate use of ancillary services;
• the design of Medicare’s traditional fee-for-service (FFS) benefit package and its impact on beneficiaries and the program overall; and 
• Medicare’s technical assistance to health care providers for quality improvement.

Full Report: Medicare and the Health Care Delivery System (PDF | 1.65 MB)

Medicare Payment Advisory Commission. (2011). Medicare and the health care delivery system.