In addition to putting in place policies and incentives to expand health insurance coverage, the Affordable Care Act (ACA) introduces and funds experiments in and expansions of new approaches to care delivery and new payment models. While much attention has been paid to the ACA's coverage expansion provisions, in the long term, the ACA's delivery and payment innovations are also likely to have a significant impact on the U.S. health care system. The Health Care Innovation Awards sponsored by the Centers for Medicare & Medicaid Services and funded by the ACA are one mechanism to encourage innovation and improvement in our health care system, and specifically in the areas of delivery and payment. In this issue of RAND Health Quarterly, Berry et al. describe a framework for use in evaluating recipients of Innovation Awards. This study tackles the challenges in evaluating delivery and payment models targeting different populations and in different clinical settings. The framework highlights the importance of implementation, impacts, and context—three crucial dimensions for policy analysis—and highlights impacts on such important subpopulations as Medicare and Medicaid dual-eligibles.
Other studies in this issue tackle a range of health policy–relevant research questions. Two studies address ACA-related research questions using the COMPARE microsimulation model. Eibner et al. simulate the potential impact of premium regulation in the nongroup and small group health insurance markets. Price and Saltzman estimate the financial impacts of the one-year delay in the employer mandate.
Three studies address issues related to posttraumatic stress disorder (PTSD). Loughran and Heaton found that reservists returning from deployments with symptoms of PTSD earn on average 6 percent less than those without PTSD symptoms. In another study, Fisher and Schell explored the potential impacts of differences in diagnostic terminology across health care systems and military services in the context of PTSD. Martin et al. evaluated the structure, activities, and implementation of a program for service members with traumatic brain injuries by analyzing information collected in semistructured interviews with program administrators and care coordinators.
Three other studies address the development of a framework for comparing the costs and benefits from operating graduate medical education programs, the evaluation in England of a Fellowships in Clinical Leadership Programme to improve leadership and the quality in health care, and a community health needs assessment of a program promoting collaboration between hospitals and federally qualified health centers in the Washington, D.C., area.
Andrew W. Mulcahy, Ph.D., M.P.P., Editor