The first year of the Affordable Care Act rollout was a busy one in which a number of health insurance and delivery system regulations were released and new provisions took effect. An estimated 2.5 million young adults gained insurance coverage. Thirteen states passed legislation to create health insurance exchanges, or signed legislation signaling an intent to establish or study state exchanges. The Center for Medicare and Medicaid Innovation launched a host of initiatives that aim to reduce costs and improve health care quality. And more than 2.2 million Medicare Part D enrollees received prescription drug discounts.
We at the Commonwealth Fund continued to track health system performance and health insurance premium trends, as well as conduct international comparisons and offer guidance on health reform implementation. Join us as we review the 10 most popular publications released in 2011, as well as the top 10 blog posts of the year.
Top 10 Publications
- Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011, The Commonwealth Fund, September 2011.
The National Scorecard on U.S. Health System Performance, 2011, updates a series of comprehensive assessments of U.S. population health and health care quality, access, efficiency, and equity. It finds substantial improvement on quality-of-care indicators that have been the focus of public reporting and collaborative initiatives. However, U.S. health system performance continues to fall far short of what is attainable, especially given the enormity of public and private resources devoted nationally to health. - Securing a Healthy Future: The Commonwealth Fund State Scorecard on Child Health System Performance, 2011, S. K. H. How, A.-K. Fryer, D. McCarthy, C. Schoen, and E. L. Schor, The Commonwealth Fund, February 2011.
The State Scorecard on Child Health System Performance, 2011, examines states’ performance on 20 key indicators of children’s health care access, affordability of care, prevention and treatment, the potential to lead healthy lives, and health system equity. The analysis finds wide variation in performance across states. - Raising Expectations: A State Scorecard on Long-Term Services and Supports, S. C. Reinhard, E. Kassner, A. Houser, and R. Mollica, AARP, The Commonwealth Fund, and The SCAN Foundation, September 2011.
This first-ever scorecard of long-term services and supports shows some states significantly out-perform others in the delivery of long-term services and supports to older adults and people with disabilities. The study finds, however, that even the top three states—Minnesota, Washington, and Oregon—have a long way to go to create a high-performing system of long-term services and supports. - High Performance Accountable Care: Building on Success and Learning from Experience, S. Guterman, S. C. Schoenbaum, K. Davis, C. Schoen, A.-M. J. Audet, K. Stremikis, and M. A. Zezza, The Commonwealth Fund, April 2011.
This report provides recommendations for ensuring the successful implementation and spread of ACOs to achieve the goals of a high performance health system. - New 2011 Survey of Patients with Complex Care Needs in 11 Countries Finds That Care Is Often Poorly Coordinated, C. Schoen, R. Osborn, D. Squires, M. M. Doty, R. Pierson, and S. Applebaum, Health Affairs Web First, Nov. 9, 2011.
Adults with complex medical conditions, including those with serious or chronic illness, injury, or disability, benefit from receiving their care from a medical home, this international health policy survey finds. - State Health Insurance Exchange Legislation: A Progress Report, S. R. Collins and T. Garber, The Commonwealth Fund Blog, June 2011.
This blog post by the Fund's Sara Collins and Tracy Garber provides a picture, as of September 2011, of where states stand in establishing the legal authority for their insurance exchanges. - Realizing Health Reform’s Potential: Will the Affordable Care Act Make Health Insurance Affordable? J. Gruber and I. Perry, The Commonwealth Fund, April 2011.
Using a budget-based approach to measuring affordability, this issue brief explores whether the subsidies available through the Affordable Care Act are enough to make health insurance affordable for low-income families. The results show that an overwhelming majority of households have room in their budgets for the necessities, health insurance premiums, and moderate levels of out-of-pocket costs established by the Affordable Care Act. - The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations, D. A. Squires, The Commonwealth Fund, November 2011.
This analysis, of Organization for Economic Cooperation and Development (OECD) health data for 12 industrialized nations, found that health care spending in the U.S. towers over the other countries and U.S. health system performance was mixed. - Promising Payment Reform: Risk-Sharing with Accountable Care Organizations, S. F. Delbanco, K. Martin Anderson, C. E. Major et al., The Commonwealth Fund, July 2011.
This report looks at the implementation of eight private accountable care organizations that use, or are planning to deploy, a shared payer–provider risk payment model. Still in an early developmental phase, these payment models vary in their design and in how they define shared risk. - State Trends in Premiums and Deductibles, 2003–2010: The Need for Action to Address Rising Costs, C. Schoen, A.-K. Fryer, S. R. Collins, and D. C. Radley, The Commonwealth Fund, November 2011.
This issue brief analyzes changes in private employer-based health premiums and deductibles for all states from 2003 to 2010, and finds total premiums for family coverage increased 50 percent across states and employee annual share of premiums increased by 63 percent over these seven years.
Top 10 Blog Posts
- State Health Insurance Exchange Legislation: A Progress Report, S. R. Collins and T. Garber, June 2011.
This blog post by the Fund's Sara Collins and Tracy Garber provides a picture of where states stand in establishing the legal authority for their insurance exchanges. - Measuring Care Coordination in Medical Homes, M. Abrams and K. Crow, October 2011.
Drawing on a chapter by Commonwealth Fund staff in a new Patient-Centered Primary Care Collaborative guide, this post outlines seven key strategies to help health systems effectively measure care coordination as a routine part of medical home activities. - Accountable Care Organization Final Regulations Give Health Care Providers More Flexibility, M. Zezza and S. Guterman, October 2011.
In this post, the Fund's Mark Zezza and Stuart Guterman outline the key changes to the highly anticipated final regulations for accountable care organizations from the Centers for Medicare and Medicaid Services. - Bending the Health Care Cost Curve: Focusing Only on Federal Budget Outlays Won't Solve the Problem, K. Davis, C. Schoen, and S. Guterman, January 2011.
This post looks at several major deficit reduction proposals as they relate to health care, finding that the proposals' focus on reining in federal spending, rather than health spending overall, could simply shift costs from the federal government to state and local governments, businesses, and families. - Lessons from Abroad: The Dutch Health Care System, Part 1, J. Cohn, September 2011.
A new international series by Jonathan Cohn, senior editor at the New Republic, launches with this exploration of the Dutch health care system, which includes many features of a high-performance health system. - The Innovation Center at One Year: Much Progress, More to Be Done, M. Zezza, M. Abrams, and S. Guterman, November 2011.
The Commonwealth Fund's Mark Zezza, Melinda Abrams, and Stuart Guterman review the Innovation Center's first year and highlight areas for future development and consideration. - Student Health Plan Enrollees to Gain New Protections Under Affordable Care Act, S. R. Collins, February 2011.
This post reviews proposed regulations that clarify how the Affordable Care Act applies to student health plans offered at colleges and universities. By classifying student health plans as individual market plans, the new regulations ensure that students will enjoy most of the consumer protections provided by the Affordable Care Act, but provide some flexibility to health plans so that they continue to offer coverage to students. - How Will the Affordable Care Act Bolster Primary Care?, M. Abrams, January 2011.
One "hidden" benefit of the Affordable Care Act is its potential to make primary care more accessible. In this post, Melinda Abrams says it will be critical for the law's primary care provisions to be funded and implemented successfully at the federal and state levels. - Too Sick to Fail: Care Coordination for the Chronically Ill, R. Nuzum, C. Marks, and M. Keenan, August 2011.
National policymakers have a vested interest in supporting and promoting effective care coordination interventions for patients with the highest health needs, say Commonwealth Fund staffers in this blog post about an Alliance for Health Reform/Commonwealth Fund briefing. - Number of Uninsured in United States Grows to 49.9 Million; Young Adults Already Benefitting from the Affordable Care Act, S. R. Collins, T. Garber, and K. Davis, September 2011.
This blog post reviews U.S. Census data showing that the number of people without health insurance climbed to 49.9 million in 2010, up from to 49 million in 2009.