| “As painful as the past year has been, the inequities and the strains placed on our healthcare systems are now uncovered and more visible than ever. And when we talk about inequities, it is now impossible for us to open the door without having an honest conversation about this systemic inequity that has been laid at our footsteps unaddressed.” | ||
| -Lloyd Dean, Chief Executive Officer, CommonSpirit Health |
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MMI Average Person Cost Trend, CY2018 to CY2021
Source: 2021 Milliman Medical Index |
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J. Nwando Olayiwola: Five
Keys To Realizing Health Equity In US Health Plans 1. Prioritizing Prevention And Wellness: Benefits And Care Delivery Redesign 2. Prioritizing Communities: Engagement And Investments 3. Prioritizing Innovation: Population And Digital Health 4. Prioritizing Education, Research, And Workforce Development: Academic-Community Collaborations 5. Prioritizing Action And Accountability: Data-Driven Improvement Source: HealthAffairs Blog, May 20, 2021 |
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The Insightful Leader Live: Understanding America's Evolving
Healthcare Ecosystem, Kellogg School of Management
Healthcare in the U.S. is a lot of things—innovative,
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minute clinics to the labs around the world developing COVID
vaccines, what goes on behind the scenes? Who gets paid, and who
does the paying? Which are the new firms entering, and with whom
are they partnering? Professor Craig Garthwaite, a leading
economist and an expert in the U.S. healthcare system, provides
an overview of the changing business of healthcare. |
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Can a Subscription Model Fix Primary Care in the US? In April, San Francisco-based primary care company One Medical revealed an eye-popping compensation package for its chief executive and chairman, Amir Dan Rubin. His $199 million payday, particularly noteworthy at a company that has yet to turn a profit, made Rubin the second-highest-paid CEO in the United States last year — but only on paper. California Healthline, June 9, 2021 Report: Which US markets are ripe for ‘payvider’ models? Certain markets in the U.S. are ripe for contractual or joint ownership arrangements between payers and providers, according to a new report by Guidehouse, a consultancy firm. These arrangements — dubbed “payvider models” — take various forms, including provider-sponsored health plans; national payers directly employing physicians; joint ventures; and long-term risk-based contracting between providers and payers. MedCityNews, June 6, 2021 Health Coverage Under the Affordable Care Act: Enrollment Trends and State Estimates Based on enrollment data from late 2020 and early 2021, approximately 31 million people were enrolled in Marketplace or Medicaid expansion coverage related to provisions of the Affordable Care Act (ACA), the highest total on record. ASPE Office of Health Policy, June 5, 2021 Urban Institute: Marketplace Premiums and Participation in 2021 In 2021, the Affordable Care Act (ACA) Marketplaces entered their eighth year of operation and appears to be approaching a steady path, as reflected by premium growth. Predictions that the federal and state Marketplaces would shrink over time or fail in some areas of the country have not come to pass, and insurer participation is increasing Urban Institute, May 2021 2021 Milliman Medical Index In 2021, the cost of healthcare for a hypothetical American family of four covered by an average employer-sponsored preferred provider organization (PPO) plan is $28,256, according to the Milliman Medical Index (MMI). Milliman, May 27, 2021 Opinion: Why Healthcare Needs A Civil Rights-Style Movement There will come a time in the not too distant future when we look back at the healthcare system as it is today with shame and embarrassment. We’ll wonder how anyone got the right kind of care and rue the policy and clinical decisions that have made our system unaffordable, inaccessible, wasteful, and inferior to our peer nations. To hear some people discuss healthcare these days, the Affordable Care Act (ACA) fixed the healthcare system. But that’s not really true. The ACA broadened the tent and made health insurance coverage available to more people. But the tent poles now need to be replaced. Forbes, May 26, 2021 The Economic and Employment Effects of Medicaid Expansion Under the American Rescue Plan The American Rescue Plan offers financial incentives for 14 states to expand Medicaid eligibility for low-income adults, as all other states have done. In these states, people below the federal poverty level have no access to Medicaid or marketplace coverage. Expanding Medicaid would yield economic benefits in addition to gains in health care access. Commonwealth Fund, May 20, 2021 |
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AMA doctors meet amid vocal backlash over racial
equity plan The nation’s largest, most influential doctors’ group is holding its annual policymaking meeting amid backlash over its most ambitious plan ever — to help dismantle centuries-old racism and bias in all realms of the medical establishment. AP, June 12, 2021 Following backlash, insurance giant UnitedHealthcare delays policy to scrutinize ER claims Facing mounting criticism from hospitals and doctors groups, health insurance giant UnitedHealthcare said it will delay a policy that would scrutinize payments for non-urgent emergency room visits. The policy to review and potentially clamp down on some hospital payments drew outcries from the American Hospital Association and the American College of Emergency Physicians about potential harm of patients' health and finances. USA TODAY, June 10, 2021 Covid Was a Tipping Point for Telehealth. If Some Have Their Way, Virtual Visits Are Here to Stay. As the covid crisis wanes and life approaches normal across the U.S., health industry leaders and many patient advocates are pushing Congress and the Biden administration to preserve the pandemic-fueled expansion of telehealth that has transformed how millions of Americans see the doctor. The broad effort reaches across the nation’s diverse health care system, bringing together consumer groups with health insurers, state Medicaid officials, physician organizations and telehealth vendors. KHN, June 7, 2021 Biden has paused a public option. Nevada is about to try its own. A federal public option isn't happening anytime soon, so Nevada officials are creating their own. The Democratic-led state legislature recently passed a bill establishing a type of public health insurance option, aimed at lowering costs and improving access to coverage for state residents. Gov. Steve Sisolak, a Democrat, has said he will sign it. The move comes as President Joe Biden focuses on passing his massive infrastructure and care plans, which would make permanent more generous federal subsidies for Obamacare policies but don't include more controversial steps to expand health care access. And it comes as the federal Affordable Care Act faces its most severe challenge before the Supreme Court, which is set to rule in the coming weeks on the fate of the landmark law. CNN, June 7, 2021 Expanding Insurance Coverage Is Top Priority for New Medicare-Medicaid Chief The new head of the federal agency that oversees health benefits for nearly 150 million Americans and $1 trillion in federal spending said in one of her first interviews that her top priorities will be broadening insurance coverage and ensuring health equity. Kaiser Health News, June 3, 2021 Privately insured face worse access, higher costs than those in public plans: JAMA report Privately insured individuals are more likely to report worse access to care, higher medical costs and lower satisfaction than those on public insurance programs like Medicare, suggesting public options may provide more cost-effective care than private ones, according to a new study published in JAMA. HealthcareDive, June 1, 2021 A new tool tracks health disparities in the U.S. — and highlights major data gaps Over and over, the pandemic has reinforced the reality of racial disparities in the U.S. health system. But that story remains difficult to see in the data, which is still inconsistently collected and reported across the country. A coalition of researchers and advocates launched a tool they hope will fill some of those gaps: the Health Equity Tracker, a portal that collects, analyzes, and makes visible data on some of the inequities entrenched in U.S. medicine. STAT, May 26, 2021 Medicaid expansion fight resurfaces in states New federal incentives to expand Medicaid coverage do not appear to be enough to convince 12 holdout states to broaden eligibility, leaving lawmakers and advocates weighing their next steps. Under the 2010 health care law, states can expand eligibility for their Medicaid programs for individuals who do not earn enough to qualify for marketplace insurance subsidies, with the federal government taking on most of the costs. Roll Call, May 25, 2021 Pandemic Leads Doctors to Rethink Unnecessary Treatment Covid-19 is opening the door for researchers to address a problem that has vexed the medical community for decades: the overtreatment and unnecessary treatment of patients. On one hand, the pandemic caused major health setbacks for non-covid patients who were forced to, or chose to, avoid tests and treatments for various illnesses. On the other hand, in cases in which no harm was done by delays or cancellations, medical experts can now reevaluate whether those procedures are truly necessary. CaliforniaHealthline, May 25, 2021 Is Your Living Room the Future of Hospital Care? Major hospital systems are betting big money that the future of hospital care looks a lot like the inside of patients’ homes. Hospital-level care at home — some of it provided over the internet — is poised to grow after more than a decade as a niche offering, boosted both by hospitals eager to ease overcrowding during the pandemic and growing interest by insurers who want to slow health care spending. But a host of challenges remain, from deciding how much to pay for such services to which kinds of patients can safely benefit. Kaiser Health News, May 24, 2021 |
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