In this report, the authors offer an initial assessment of clinically integrated networks (CINs) based on interviews with health system executives, describe how health systems (large and small) are using CINs strategically to compete in crowded health care markets, and identify why CINs bear watching by the Federal Trade Commission and the larger health care community.
This brief describes how a public option for health care—that is, a government-sponsored health insurance plan with publicly determined provider payment rates—would affect insurance costs and coverage.
There is growing interest in a "public option" for individual market insurance to improve affordability and enrollment. The authors consider four public option alternatives that vary based on the rates providers are paid, whether the option is implemented on or off Health Insurance Marketplaces, and whether premium tax credits are available to higher-income individuals.
Although the federal government is no longer making cost-sharing reduction (CSR) payments to insurers, insurers are still required to provide CSR subsidies to qualifying enrollees. As a result, to fund CSRs, most states and insurers have adopted a practice known as silver loading, in which only the premiums of silver-tiered individual market plans are increased. In this report, the authors address the effects of disallowing this practice.
In this report, the authors analyze how allowing adults ages 50 and older to buy into the Medicare program could affect health insurance coverage, individual market premiums, and federal health care spending. Their findings suggest that a Medicare buy-in could offer significantly more-affordable coverage to older adults while potentially leading to higher premiums for the pool of people remaining on the individual market.
Earlier research established that the federal government would likely save money if federal cost-sharing-reduction (CSR) payments to insurers under the Affordable Care Act were restored, but total health insurance enrollment would decrease. The authors of this report analyze what would happen if federal lawmakers used the savings from restoring CSR payments to provide additional health insurance subsidies or to finance reinsurance.
In a survey of community health center medical directors in 9 Medicaid expansion states and DC, nearly 60% reported difficulty obtaining new specialist visits and multiple access barriers on behalf of their patients.
Following Medicaid expansion, non safety-net hospitals experienced a greater percentage increase in Medicaid stays than did safety-net hospitals, which may reflect patient choice or a crowd-out of private insurance.
Under alternative assumptions about consumer responses, we find that enrollment falls by 2.8 million to 13 million people nationwide and premiums for bronze plans increase by 3 percent to 13 percent when the mandate penalty is removed.
When new mothers have affordable access to lactation support services and breast pumps, they are more likely to breastfeed until their infants are ready to transition to solid foods.
Physician practice engagement with alternative payment models (APMs) would be enhanced by simpler APMs, a slower pace of change, greater support for new capabilities and timely data, and reexamination of practice response to APMs with financial risk.
This report, sponsored by the American Medical Association (AMA), describes how alternative payment models (APMs) affect physicians, physicians' practices, and hospital systems in the United States. Payment models discussed include fee for service, capitation, episode-based and bundled, shared savings, pay for performance, retainer-based, and combined payment models such as medical homes and accountable care organizations.
The options analyzed would increase individual market enrollment by 400,000 to 3.2 million in 2020. Net increases in total enrollment (300,000 to 2.4 million) are smaller because of offsetting decreases in employer-sponsored insurance.
Middle-income adults ages 50-64 would have more affordable coverage if the ACA's tax credits were extended to all income groups; this would improve the individual market risk pool because premiums for this group would exceed the cost of their care.
The dependent care expansion increased use of mental health care among a patients with significant mental health needs without lowering quality of care or increasing racial or ethnic disparities in access.
How will elimination of the Affordable Care Act's individual mandate penalty affect the nongroup insurance market in the state of New York? Researchers used RAND's COMPARE microsimulation model to estimate the effects, taking into account New York's unique health care landscape.
Prior to the ACA, Medicare Advantage (MA) enrollment growth led to small reductions in inpatient for the entire population over age 65. After the ACA, this impact diminished, contrary to the hypothesis that the MA ACA payment would amplify this effect.
Extending the duration of short-term individual health plans will have little effect on premiums or enrollment in the individual market.
This report reviews the features of tax-based approaches to subsidizing health insurance, including tax credits and tax deductions, and summarizes their associated benefits and drawbacks. Different approaches could affect consumer premium payments, health insurance enrollment, federal costs, total health spending, and work incentives.
Efforts to create high-functioning primary care teams should take advantage of the knowledge and skills of clinical pharmacy specialists
