Alan R. Weil

Big Data In Health: A New Era For Research And Patient Care

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Toward Universal Coverage in Massachusetts

This paper presents several options designed to help the Commonwealth of Massachusetts move to universal health insurance coverage. The alternatives all build upon a common base that includes an expansion of the Medicaid program, income-related tax credits, a purchasing pool, and government-sponsored reinsurance. These measures in themselves would not yield universal coverage, nor would an employer mandate by itself. We show that an individual mandate, and an employer mandate combined with an individual mandate, both would yield universal coverage with a relatively small increase in government costs relative to state gross domestic product and current health spending. The cost of an employer mandate—with a “pay or play” design—is sensitive to the payroll tax rate and base, the number and kind of exemptions, and whether workers whose employers “pay” receive discounts when they purchase health insurance. The development of these alternatives and their analyses contributed to the eventual health care compromise that emerged in Massachusetts in April 2006.

New roles for states in health reform implementation.

State policies and implementation practices will largely determine whether the new federal health reform law translates into more affordable coverage and access to health care services. States will play particularly important roles with respect to Medicaid expansion, the creation of insurance exchanges, and the new market rules for insurance. The decision of whether or not to create an exchange looms as the most important and consequential one for states. To achieve effective implementation, each state will need a coherent vision to guide its work. States will need help from the federal government and stakeholders and must learn from each other during implementation.

High-Cost Populations, The ACA, And More

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It Takes A Community

from the Publisher. All rights reserved. including photocopying or by information storage or retrieval systems, without prior written permission may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, Health Affairs Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of by Project HOPE The People-to-People Health 2014 Bethesda, MD 20814-6133. Copyright

The Cost And Quality Of Cancer Care

9:50 a.m. Valuing Cancer Care Innovation Tomas Philipson, Daniel Levin Professor of Public Policy, Irving B. Harris School of Public Policy Studies, University of Chicago, on Quality-Adjusted Cost Of Care: A Meaningful Way To Measure Innovation Cost Growth Versus The Value Of Health Gains Warren Stevens, Senior Research Economist, Precision Health Economics, on Cancer Mortality Reductions Were Greatest Among Countries Where Cancer Care Spending Rose The Most, 1995-2007

The Promise Of Biomedical Innovation

without prior written permission from the Publisher. All rights reserved. mechanical, including photocopying or by information storage or retrieval systems, may be reproduced, displayed, or transmitted in any form or by any means, electronic or States copyright law (Title 17, U.S. Code), no part of by Project HOPE The People-to-People Health Foundation. As provided by United Suite 600, Bethesda, MD 20814-6133. Copyright

Aging And Health

from the Publisher. All rights reserved. including photocopying or by information storage or retrieval systems, without prior written permission may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, Health Affairs Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of by Project HOPE The People-to-People Health 2015 Bethesda, MD 20814-6133. Copyright

The Growing Burden Of Noncommunicable Diseases.

The leading cause of death and primary source of disability globally, noncommunicable diseases, as Mohammed Ali and colleagues write, “are associated with catastrophic health expenditures, high opportunity costs, and lost productivity.” Growing wealth has reduced the burden of infectious diseases, while it has increased the risk factors for some chronic diseases. Heart disease, respiratory disease, cancer, diabetes, mental illness, and other noncommunicable diseases demand our attention. As with all global health matters, the disease burden and responses to that burden vary widely from country to country. Ali and colleagues map changes in disease mortality by country over more than three decades and find highly variable trends. They report significant reductions in mortality in some areas, reflecting effective health system responses, but they note: “In other cases, flat or increasing mortality rates reflect rapid societal transitions, the absence of interventions, or both.” Despite causing the majority of deaths in developing countries, noncommunicable diseases receive little global aid funding, and that funding is directed disproportionately to higher-income countries. Thomas Bollyky and colleagues examine the relationship among country wealth, unhealthy lifestyles, and noncommunicable diseases. They find strong evidence for potentially significant health benefits in lowand middle-income countries through expanding the use of low-cost interventions—both preventive and curative—that are readily available in higher-income countries. improving care systems With noncommunicable diseases poised to overtake communicable diseases as the leading cause of death in East Africa, Trishul Siddharthan and colleagues explore how major investments in treating AIDS, tuberculosis, and malaria can be leveraged to address these emerging diseases. Seeking to avoid the pitfalls of prior approaches, they conclude: “If the focus remains on disease-specific impact packages (interventions aimed at decreasing morbidity and mortality of single-disease entities) and noncommunicable disease targets, further fragmentation of health resources will occur.” Noting that “universal health coverage provides the opportunity to retool health systems to introduce care delivery models for chronic conditions that span the care continuum and the life course,” Felicia Marie Knaul and colleagues use the case study of breast cancer care in Mexico to describe how such a system should function. Vikram Patel and Somnath Chatterji describe the bidirectional relationship between mental disorders and other noncommunicable diseases, with each increasing the burden associated with the other. Observing that “in most countries—both those in the lowand middle-income group and those in the high-income group—the management of mental disorders and noncommunicable diseases largely ignores the existence of multiple morbidities, in a single patient and in household members,” the authors view integration at the primary care site as the necessary platform for better care. Peer support is an evidence-based approach to improving chronic care. Drawing upon the Peers for Progress program, Edwin Fisher and colleagues describe elements of effective programs that rely on community health workers, promotores, and lay health advisers. Finding a strong commitment to such care in the Affordable Care Act and globally in a call to action by the World Health Organization, they conclude: “The next steps are to address how to tailor peer support to different problems, populations, and settings; to identify what...structures it requires; and to determine how to pay for it.”

Chronic Care, Prescription Drugs, And More

Chronic Care Consistent care is important for everyone, but particularly for those with chronic conditions for whom an interruption in care can lead to exacerbation and medical complications. Mary Rogers and colleagues report on a longitudinal study of adults with type 1 diabetes. Over the course of an average 2.6year period of insurance, one out of four adults experienced at least one thirtyday spell without coverage. Those who experienced a coverage gap were five times more likely to have an acute care medical visit in the thirty days after the gap than in the thirty days before it. The United States has adopted the WorldHealth Organization (WHO) goal of eliminating the public health burden of viral hepatitis B by2030.Near-universal vaccination in the US means that hepatitis B control is largely dependent upon identifying and treating people born outside the US. Mehlika Toy and colleagues model the effects of increasing screening and treatment to achieve rates of 90 percent identification and 80 percent treatment by 2025 or 2030. They find that anapproach that achieved the WHO goals by 2025 would generate health-related savings as the lower disease burden more than offset screening and treatment costs, while also adding hundreds of thousands of qualityadjusted years of life.