IMPAQ Health News
From our experts to your inbox. Every two weeks.
Coronavirus (COVID-19)
Global News
Outside of China, three countries account for almost 80 percent of all cases (South Korea, Iran, and Italy). The World Health Organization (WHO) continues to emphasize preparedness and containment, and recently released a Q&A video on COVID-19 in the workplace .
US News
As of Thursday, 3/5, the Centers for Disease Control and Prevention (CDC) reports cases in 13 US states. Track regional spread of the disease using this frequently updated map from Johns Hopkins University.
Administration Response
CMS announced actions it is taking to address the spread of COVID-19 in a press release on 3/5. In a White House Press Briefing on the issue, Vice President Pence, who is leading the administration’s response to COVID-19, stated that “HHS has designated the coronavirus test as an essential health benefit.” Read more about the $8.3 billion emergency response package making its way through Congress here . New York Times (3/4)
Beyond the Headlines

  • Creative solutions: In King County in Washington state, officials are planning to purchase a motel and repurpose modular housing units to isolate infected individuals.
Rules & Reports
A Yale study , published in The Lancet and touted by Senator Bernie Sanders, has concluded that under Medicare for All, the US would spend about $460 billion less on health care than what was spent in 2017, and universal coverage would save roughly 69,000 lives annually. However, this study relies on the assumptions that provider payment rates would mirror those under Medicare, administrative costs would remain between 2-6 percent, and service utilization would only increase among the 24 percent of Americans granted access to insurance coverage under the program. Deviations from the proposed payment rates or estimated administrative overhead, combined with increased utilization of the other 76 percent of Americans, could impact the savings under Medicare for All. Vox (2/26)
A study analyzing the Medicare Shared Savings Program (MSSP), a program launched by CMS in 2012 to reduce spending and improve quality, has indicated the program's modest capacity to curb health care spending. Variation across accountable care organizations' (ACOs) performance driven by the differences in out-of-network care utilization was found to be one of the barriers to spending reductions. The association between higher levels of out-of-network primary care and higher health care spending suggests the need for policy incentives for ACOs to keep primary care services within their provider networks. Health Affairs (2/2020)
Health Insurance Marketplaces & Medicaid
The Supreme Court has agreed to hear challenges to the ACA's individual mandate this fall. California v. Texas, the third major case against the healthcare law, stems from a ruling by a Federal District Court judge in Texas, which argued the ACA was invalid due to the repeal of the individual mandate in 2017. The New York Times (3/2)
A variety of health care industry groups, including insurers, associations, providers, and unions, have voiced opposition towards the CMS proposal to end automatic re-enrollment for low-income individuals on ACA Exchange plans. In the Plan Year 2021 Proposed Rule , CMS solicited feedback on whether the agency should eliminate or reduce the tax credits for subsidized enrollees who pay $0 premiums unless they re-enroll in coverage during open enrollment. By ending automatic re-enrollment, CMS states that it could limit premium tax credit payouts for those who are ineligible. Industry stakeholders, including health insurers and their trade associations, argue that the proposal would disproportionately affect low-income individuals and lead to higher uninsured rates. Modern Healthcare (3/2)
The Trump administration has denied New York’s request to extend funding for the Delivery System Reform Incentive Payment Program (DSRIP). The Medicaid reform program, designed in 2014 to allow New York to use federal funding to reduce avoidable hospital use, promoted the use of community medical facilities rather than traditional hospitals. The $8 billion request was meant to fund the DSRIP for an additional four years. Funds were allocated to expand New Yorks’s health care workforce, address social determinants of health, and invest in safety-net hospitals. Modern Healthcare (2/25)
Last week, Colorado introduced the formula for hospital reimbursement rates under The Colorado Health Insurance Option. The public insurance option's formula includes a base rate of 155 percent of Medicare and individual rates for hospitals that would depend on the hospital's size and ownership structure, payer mix, and delivery efficiency. According to an actuarial analysis , the hospital reimbursement formula would save an average of 12 percent on premiums for Colorado residents purchasing insurance through the individual market. Modern Healthcare (2/25)
Quality Measurement & Value-Based Care
In a review of the ACA's major payment and delivery system reforms, researchers from the Commonwealth Fund studied the law’s effect on costs. The report examined the law's major health care delivery reforms and notable initiatives and concluded that, while the initiatives show promising trends, there is still more to be done in presenting a remedy for cost and quality issues. However, the report did indicate that:

  • Payment reductions in Medicare were effective;

  • Holding providers accountable for cost and quality in ACOs was effective in increasing value;

  • CMS’ Center for Medicare & Medicaid Innovation (CMMI) has benefited the research and development of novel payment and delivery reforms. The Commonwealth Fund (2/26)
Given the recent national conversation on rising maternal morbidity and mortality in the United States, researchers have identified three major impediments to measuring quality in prenatal care services. First, researchers suggest using metrics to accurately reflect dimensions of prenatal care, second, improving data collection, and third, addressing empirical challenges to evaluate the association between prenatal care and maternal and infant health outcomes. Addressing issues with data collection and evaluation could improve prenatal care quality and reduce poor maternal and infant health outcomes. Health Affairs (2/26)
The Center for Health Care Strategies, with support from the SCAN Foundation, has assessed Medicare-Medicaid integrated care models in early-adopter states. Their analysis identified trends among states' economic and political environments, incentives, and internal capacities that led to successful integrated care models. For example, the analysis indicated the necessity for states to reassess how long-term services and supports are provided in local communities and to develop foundational Medicare policy knowledge. Center for Health Care Strategies (2/2020)
Social Determinants of Health
Humana’s new initiative, the social determinants of health value-based program, is designed to reimburse health care providers for referring Medicare Advantage beneficiaries to social services. Providers will screen Medicare Advantage patients for potential social determinants of health needs and connect them to an appropriate service offered in the community or by Humana. Reimbursement will be determined by tracking screenings, evaluations, and referrals. Modern Healthcare (3/4)
Graphic of the Week
Source: CDC
The CDC wants you to know: Mutton chops and masks don’t mix. But remember, they also do not advise mask use for the general public and stress that improper use can put you at greater risk of infection.
Health Policy - Upcoming Events, Trainings, Tools, & Webinars
The Hamilton Project at the Brookings Institution will host a forum exploring ways to lower health care costs through competition, regulation, and reduced administrative expenses. The forum will begin with a fireside chat between American University President Sylvia M. Burwell and Sarah Kliff of The New York Times; it will also include a research presentation by David Cutler of Harvard University. Register here.
The March 2020 issue of  Health Affairs , “The Affordable Care Act Turns 10,” offers must-read analyses of the ACA. Authors explain the law’s effects on coverage, cost, health status, and more. They also review the political and legal issues that have shaped implementation and consider what should come next. On Tuesday, March 10, Health Affairs will host a special event to amplify the work. Register here.  
March 11, 2020
Washington, D.C.
The United States spends more on health care than any other developed country. Insurance, hospital visits, medication, imaging, and lab testing—all cost more here. Yet for all of this spending, the United States consistently ranks near the bottom of the list of industrialized nations when it comes to the health of its citizens. What would it take to bring the country’s health-care costs in line with its peer countries? And can it be done without sacrificing the quality of care? Register here.
On Wednesday, March 18, the Kaiser Family Foundation and the National Academy for State Health Policy will hold a public forum to explore state experiences under the Affordable Care Act and how the 2020 elections could shape the future of state health reform. Register here.
Ready or Not: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism   is an annual report measuring states’ level of preparedness to protect the public’s health during an emergency. Based on 10 performance indicators and by tracking public health funding, the report ranks states’ level of preparedness into three performance tiers: high, middle and low. Register here.
NOTE: The information, analyses, and opinions expressed in the articles, publications, or comments contained therein are those of the authors and should not be considered verified or endorsed by IMPAQ or any of our partners or clients.
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