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Episode-Based Payments: Charting a Course for Health Care Payment Reform

Excerpt: As consensus grows that true reform of the U.S. health care system requires a move away from fee-for-service payments, designing alternative payment methods, including episode-based payments, has emerged as a high priority for policy makers. An episode-based payment approach would essentially bundle payment for some or all services delivered to a patient for an episode of care for a specific condition over a defined period. Ideally, a well-designed episode-based payment system would encourage providers to improve efficiency and quality of care.

State Benefit Mandates and National Health Reform (PDF)

This analysis describes the range of current state benefit mandates, federal health reform law provisions that will affect state approaches to benefit mandates, and the benchmark plans that states can use to define the essential health benefit package for new nongroup and fully insured small-group health plans. The analysis also examines Maryland, a state with a wide array of benefit mandates, to illustrate how mandates interact with essential health benefits.

Health Care Reform by the Numbers - Factoring in the Argument from Statistics

Excerpt: An article appearing in the Wall Street Journal yesterday gives context to the frequently cited U.S. health care spending statistics. Consider ... two widely published observations .... Should these points provide impetus for a universal government-run health care system? Would this solution enhance national competitiveness? No, says John Graham, Director of Care Studies at the Pacific Research Institute in the WSJ article, 'The Health Cost Myth' (November 13, 2007).

Statement of Center for Studying Health System Change at Senate Finance Committee Hearing on Health Care Costs (PDF)

"To date, most policy activity related to health care price transparency has missed the mark and has not achieved the prime goal of lowering prices by engaging consumers to choose providers on the basis of value. Without changes in insurance benefit designs that steer patients to high-value providers -- those that provide high-quality care efficiently -- price transparency initiatives are likely to continue to have limited impact."

Why Massachusetts Governor Romney's Health Care Reform Won't Work

Excerpt: Massachusetts has enacted one of the most far-reaching state health insurance reform packages in recent decades.... Many observers see Massachusetts's reforms as a model for the nation, but a closer look provides ample reasons to be skeptical. (Originally published June 6, 2006)

Geographic Variation in Health Care: Changing Policy Directions

This Policy Analysis reviews evidence and key inferences from geographic variation research that have helped shape the ongoing policy debate about health care efficiency. More recent research, employing improved data and analytical approaches, indicates that unwarranted geographic variation is less extensive than believed.

Employer-Sponsored Insurance and Health Reform: Doing the Math

"Almost 60 percent of Americans younger than 65 obtain health insurance through an employer, but the proportion is steadily declining, largely because of rising health care costs. The decline in employer coverage has disproportionately affected low-wage workers and those in small firms.... Following reform implementation in 2014, workers in large firms, those with a union presence and those in higher-wage industries, such as professional and financial services, will see modest changes in their employers' economic incentive to offer coverage. However, other workers will face large changes."

The Concentration of Health Care Spending

"Spending for health care in the U.S. is highly concentrated among a small subset of Americans. Just 5 percent of the population accounted for nearly half of all health care spending in 2009. Understanding these high-spenders is vital for developing strategies to reduce overall spending growth. [This data brief describes] the characteristics and health conditions of the highest spenders, the persistence of high spending patterns over time, the challenges in targeting the most expensive cases for better care management, and the implications of concentrated spending for risk-based payment and insurance market reform."

The Case for Public Plan Choice in National Health Reform (PDF)

27 pages. Excerpt: This policy brief sets out the argument for public plan choice. The core argument is that public insurance has distinct strengths and thus, offered as a choice on a level playing field with private plans, can serve as an important benchmark for private insurance within a reformed health care framework. This is not an argument for a universal Medicare program, but instead for a 'hybrid' approach that builds on the best elements of the present system -- large group plans in the public and private sectors -- while putting in place a new means by which those without access to secure workplace insurance can choose among health plans that provide strong guarantees of quality, affordable coverage. The case made in this brief is that this menu of health plans must include a good public plan modeled after Medicare if the broad goals of reform -- universal insurance and improved value -- are to be achieved.

Health Status and Hospital Prices Key to Regional (PDF)

Differences in health status explain much of the regional variation in spending for privately insured people, but differences in provider prices -- especially for hospital care -- also play a key role, according to a study by the Center for Studying Health System Change (HSC) based on claims data for active and retired nonelderly autoworkers and dependents. Although autoworkers' health benefits essentially are uniform nationally, health spending per enrollee in 2009 varied widely across 19 communities with large concentrations of autoworkers, from a low of $4,500 in Buffalo, N.Y., to a high of $9,000 in Lake County, Ill.