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International — Comparing the USA, UK and 17 Western countries’ efficiency and effectiveness in reducing mortality

The objective of this study was to test the hypothesis that the USA healthcare system was superior to the NHS and 17 other Western countries in reducing feasible mortality rates over the period 1979–2005. In cost-effective terms, i.e. economic input versus clinical output, the USA healthcare system was one of the least cost-effective in reducing mortality rates whereas the UK was one of the most cost-effective over the period.

USA - Health Reform 2.0: A Call to Action

Committed to ensuring that all Americans have high-quality affordable health care, Families USA presents this report on ways to achieve that aim by enhancing the quality of care and reducing care costs. The report calls for expanding state Medicaid and strengthening children’s coverage, reducing prescription drug costs, and halting the uncompetitive consolidation of providers.

USA - The Role of Physician Assistants in Health Care Delivery

The role of physician assistant (PA) was created in the 1960s to relieve a shortage of doctors and is a versatile component of the US health care workforce. This brief describes the contemporary functions of PAs and barriers that may still prevent their maximum usage. The authors conclude with specific policy considerations for US state health officials.

USA - Cost Savings Possible from Reducing Use of Low-Value Health Services

The first national study in the US to examine spending on low-value health services has found that usage remains modest but that there is still potential for cost savings. The study looked at services that provide little value to patients because of cost and available alternatives.

USA - Historically Slow Growth in Health Spending Continued in 2013

New data from the US Government confirms that 2013 was another year of historically slow growth in healthcare spending after three years of the slowest growth on record. Although the slow growth is often attributed to the underperforming US economy, the data shows it also reflects structural changes to the American health system, including the 2010 Affordable Care Act.

USA - America's Health Rankings 2014

First published in 1990, America’s Health Rankings presents comparative health data for all 50 US states. The 2014 edition finds that Hawaii is the healthiest US state due to low rates of smoking, obesity, income disparity and cancer mortality. The state of Mississippi ranked 50th, coming in last on 18 of 26 measures.

USA - Too High a Price: Out-of-Pocket Health Care Costs in the United States

Whether they have employee health insurance or buy it on their own, Americans are now paying more out-of-pocket for health care than they did previously. This October 2014 survey by the Commonwealth Fund asked US consumers about out-of-pocket costs. It found that low-income adults have the highest costs and that half of privately insured adults find it difficult to afford their deductibles.

USA - Beacon Communities Share Strategies for Using Health Information Technology in New eGEMs Special Issue

The online journal, eGEMS, has published a special issue on lessons learned from eight ‘Beacon Communities’ that are using information technology (IT) to achieve better health care at lower costs. Beacon Communities are part of a program by the Office of the US National Coordinator for Health IT to strengthen health IT infrastructure, reduce costs and improve care quality.

USA - Four years on: A status report on Obamacare implementation

This article presents a detailed history of Obamacare, and explores its rationale, mechanisms and early effects on the proportion of people with health insurance and on healthcare costs. It was published in the Chronique internationale de l'IRES.

USA - Surgical complications are top reason for hospital readmissions

According to a study from Harvard University, surgical complications are the top reason for hospital readmission in the US. The authors looked at 500,000 operations conducted in 2012 and found a nearly 6% overall hospital readmission rate. Most readmissions were attributable to surgical wound infections. Nationwide, the annual total number of post-surgical infections is estimated at around 170,000.

USA - Challenges facing the United States of America in implementing universal coverage

The Affordable Care Act (ACA) became US law in 2010. This article assesses its impact on universal coverage in the US, and says the legislation remains incomplete. For example, due to lobbying by insurers, the ACA prohibits the creation of institutes comparable to France’s Haute Autorité de Santé (HAS) or the UK National Institute for Health and Care Excellence (NICE).

USA - Linking Costs to Health Outcomes for Allocating Scarce Public Health Resources

In the US, public health (PH) resources are scarce and policymakers face tough decisions on funding priorities. Accounting systems, which are ill equipped to link fiscal resources to PH outcomes, compound these difficulties. This paper examines the types of expenditures, services, and outcomes tracked at local and state PH levels. The authors provide recommendations for strengthening the linkage between expenditures and outcomes.

USA - HHS Secretary announces $840 million initiative to improve patient care and lower costs

The US Department of Health & Human Services (HHS) has announced an $840 million initiative to improve care and lower costs. The HHS will fund the redesign of medical provider and health professional practices from systems driven by quantity of care to ones focused on outcomes and coordinated services. Eligible applicants for funding include group practices and medical provider associations.

USA - After Decline in U.S. Health Expenditure Growth, OECD Sees Risk of Spending Uptick in Recovery

This paper published in The Lancet states that unless efforts are made to contain spending, slowing health expenditure growth in the US could be negated by price increases associated with the country's economic recovery. The paper finds that growth in per-capita expenditure, which declined sharply between 2000 and 2011, is accelerating as health sector prices rise.

USA - Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally

In this latest update of the Commonwealth Fund's comparative assessment of healthcare systems, the US once again comes first in expense and last or near last in access, efficiency and equity. The UK ranks first on most measures, despite coming in 10th out of 11 countries in terms of healthy lives.

USA - Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure

The Office of the National Coordinator for Health Information Technology recognizes, in this document, the progress made in implementing a health IT infrastructure in the US. It also presents a vision of the work that remains to be done to achieve the next stage: a learning health system built on interoperable health IT products that allow for constant improvement. The National Coordinator aims to achieve this progress by 2024, and enumerates the guiding principles it will follow along with milestones it hopes to reach at 3, 6 and 10 years.

USA - $15 Billion Annual Public Financing System for Physician Training Needs Overhaul To Meet Nation’s Health Care Needs, Says New IOM Report

A report by the Institute of Medicine (IOM) says the US should reform the system for financing physician training to ensure the $15 billion annual investment is producing doctors the nation needs. The system's current financing has little accountability, allocates funds independent of workforce needs, and offers insufficient opportunities to train physicians in commonly-used healthcare settings.

USA - Investing in Global Health Systems: Sustaining Gains, Transforming Lives

This Institute of Medicine (IOM) report looks at how health system improvements can increase health, reduce poverty, and make donor investment in health sustainable in the world’s poorest countries. The report outlines a broad donor strategy that can make effective use of the US comparative advantage in science and technology to improve health internationally.

USA - Managing for Results: Agencies' Trends in the Use of Performance Information to Make Decisions

Produced by the US Government Accountability Office (GAO), this report is an assessment of 24 US government agencies’ use of performance information from 2007 to 2013. After surveying agency management, the report created an index to measure how performance information is used. Its findings show that the use of performance information did not change over the study period.

USA - Improving Care Delivery Through Lean: Implementation Case Studies

Lean is an organizational redesign approach increasingly used in health systems to eliminate waste and improve performance without adding costs. This study assesses the application of Lean in six US healthcare organizations. It finds that the goals, content, implementation and context of Lean programs varies widely, perhaps because Lean itself is often described differently in the literature.

USA - Small Primary Care Physician Practices Have Low Rates of Preventable Hospital Admissions

This Commonwealth Fund study examines the relationship between quality of care and practice size. It finds that practices with one or two physicians had 33 percent fewer preventable hospital admissions than practices with 10 to 19 physicians, and practices with three to nine physicians had 27 percent fewer admissions. As well, practices owned by physicians had significantly lower ambulatory care–sensitive admission rates than those owned by hospitals.

USA - Hospital Guide to Reducing Medicaid Readmissions

The US Agency for Healthcare Research and Quality commissioned this guide to identify ways evidence-based strategies to reduce readmissions can be adapted or expanded to better address the transitional care needs of the adult Medicaid population. It presents a roadmap of tools and discusses their use.

USA - Hospital Based Strategies for Creating a Culture Of Health

US hospitals are playing a greater role in building a community culture of health in which getting and staying healthy is a guiding social value. This report develops principles and strategies for hospital-based community programs to build a culture of health messaging. It describes ways to identify action areas for focus and measurement in communities.

USA - Implementing administrative evidence based practices: lessons from the field in six local health departments across the United States

Administrative evidence based practices (A-EBPs) are agency level structures and activities that are positively associated with performance measures. This study explores differences in local health department (LHD) characteristics that influence the implementation of A-EBPs. It finds that LHDs that implement A-EBPs are more likely to have strong leadership, professional development activities, financial flexibility and academic partnerships.

USA - MEDICARE: Results from the First Two Years of the Pioneer Accountable Care Organization Model

American health care providers form accountable care organizations (ACOs) to offer coordinated care and reduce spending. Under the Pioneer ACO model introduced in 2012, ACOs earn additional Medicare payments if they generate savings, but pay penalties if spending rises. This report finds that fewer than half of participating ACOs generated savings in the model’s first two years.

USA - About 137 million individuals with private insurance are guaranteed access to free preventive services

The US government has released data showing that 137 million Americans with private health insurance now have guaranteed access to free preventative services under provisions mandated by the 2010 Affordable Care Act. The services include blood pressure screening, obesity prevention, immunization, tobacco cessation, mental health interventions, domestic violence counselling and HIV testing.

USA - Reducing Health and Health Care Disparities: Implementation Lessons and Best Practices for Health Care Organizations

Undertaken to address health disparities more effectively, this paper shares lessons from nine US healthcare organizations on programs designed to address disparities between patient populations. The paper offers concrete recommendations to improve the quality of healthcare delivery systems and implement interventions to tackle inequities in patient care and outcomes.

USA - Working Under a Clinic-Level Quality Incentive: Primary Care Clinicians’ Perceptions

Some designers of clinician pay-for-performance programs argue that team-level incentives (where members receive identical incentives based on overall performance) are most effective. This study surveyed 198 primary care clinicians to obtain opinions on a team-based quality incentive awarded at the clinical level. Most of the clinicians (73%) favoured a mix of clinic-level and personal incentives to maintain collaboration while also recognizing individual performance.

USA - Transforming Health Care Scheduling and Access: Getting to Now

According to this report, long waits for treatment typify the way most health systems have evolved to accommodate doctors and administrators. The report says that utilizing systems engineering, new management approaches and patient engagement can enable health systems to reduce wait times without additional personnel or investment. Ways to promote efficient physician scheduling are emphasized.

USA - Measuring the quality of healthcare in the U.S.

The American healthcare system is vast, and has no easy way to determine the quality of its products and services. This brief describes various approaches to measuring the quality of US health care and provides trend and comparative statistics on key measures. Available data suggests the quality of US health care is improving, but is falling short of other developed countries.

USA - Making Open Innovation Ecosystems Work: Case Studies in Healthcare

This report addresses the use of ‘open innovation’ approaches in health care, especially the adoption of external ideas to direct internal innovation to consumers. The approach is studied using two case studies analyzing technological ecosystems built around the introduction of new electronic health record software. The authors identify best practices, including transparency and the minimization of bureaucracy.

USA - Policy Recommendations to Guide the Use of Telemedicine in Primary Care Settings: An American College of Physicians Position Paper

The American College of Physicians (ACP) has issued 23 policy recommendations on primary care telemedicine that buttress calls for its expansion, especially in established physician-patient relationships. The ACP supports government funding of the broadband infrastructure needed for telehealth and advocates lifting restrictions limiting the reimbursement of telemedicine services by US Medicare.

USA - The convergence of health care trends. Innovation strategies for emerging opportunities

Powerful trends in the US healthcare market are creating opportunities for innovation in community care, preventive care, personalized care and chronic care. This article by consultants at Deloitte says healthcare organizations should capitalize on these opportunities, and provides a model called ‘Ten Innovation Types,’ which details the building blocks of innovation that organizations should consider.

USA - $169 million in Affordable Care Act funding to 266 community health centers

In August 2015, the US government announced funding of $169 million for new community health centres in 46 American states. Made available by the 2010 Affordable Care Act (ACA), the funding will increase access to primary healthcare services for over 1.2 million patients and add to the 700 new health centres that have already been funded.

USA - Redefining Health Care Systems

Published by the RAND Corporation, this downloadable 144-page book discusses health services research over the past 50 years and how this research base can stimulate innovation to make patient-centred healthcare systems safer, more efficient, and cost-effective in their responses to increasingly diverse communities. The role physicians can play as thought leaders is emphasized.

USA - The Impacts of Local Health Department Consolidation on Public Health Expenditures: Evidence From Ohio

The consolidation of municipal and county local health departments (LHDs) is perceived as a way to reduce costs. This study examined the effects of 20 city-county LHD consolidations in Ohio on total and administrative expenditures from 2001 to 2011. The study found that consolidated LHDs reduced total expenditures by almost 16%, although no significant change was seen in administrative expenditures.

USA - New Physician Workforce Projections Show the Doctor Shortage Remains Significant

According to a new study by the Association of American Medical Colleges (AAMC), the US will face a shortage of between 46,000 and 90,000 physicians by 2025. The study, which takes into account demographics and recent changes to care delivery and payment methods, projects shortages in both primary and specialty care, with particularly acute specialty shortages.

USA - Report to the President. Better Health Care and Lower Costs: Accelerating Improvement through Systems Engineering

This report from the President's Council of Advisors on Science and Technology identifies a comprehensive set of actions for enhancing health care across the US through greater use of systems-engineering principles. The council regards the fee-for-service payment model as the major barrier to using systems methods and tools in health care, and recognizes health data and health information technology as crucial to implementing and achieving benefits with systems methods.

USA - The Lean Way: How California Public Hospitals Are Embedding a Culture of Improvement

Lean management is an organizational redesign approach used in health systems to eliminate waste without adding costs. This article describes the efforts of five public hospitals in the San Francisco area to improve performance by integrating Lean techniques at management, clinical and support levels. Case studies highlight progress and lessons learned.

USA - Case studies in emergency medicine: Integrating care for the acutely ill and injured

The Brookings Institute offers this look at ways to improve emergency medicine in the US. While the authors find that the acute care itself is excellent, patient education and care coordination are not reimbursed and this works to the detriment of integration, follow-up and post-discharge services. Case studies highlight successful care models in emergency medicine developed for a May 2015 event by medical and health policy experts.

USA - Lessons Project Report Showcases Promising Pathways to Make Research More Accessible and Actionable

Promoting research synthesis, translation and dissemination, this report from a 2014 workshop identifies useful innovations and strategies from disciplines relevant to health services research communication. The report highlights the importance of relationships between researchers and policymakers for improving the uptake of research findings.

USA - AHRQ Report Shows Disparities Persist, Despite Improvements in Quality and Access

Released in April 2015, this report by the US Agency for Healthcare Research and Quality (AHRQ) provides a snapshot of healthcare disparities across the US. While insurance coverage for Black and Hispanic Americans has grown, disparities persist and are worsening for households below the poverty line.

USA - Health Impact Assessment Legislation in the States

Many US states are considering bills to require the use of health impact assessments (HIAs) or the adoption of parts of their methodologies. This briefing note looks at the efforts of eight states and highlights key considerations for readers interested in the introduction of HIA legislation in other states.

USA - New funding gives states and innovators tools and flexibility to implement delivery system reform

The US Department of Health and Human Services is providing significant funding to innovative models designed to deliver better care outcomes and lower costs. The Health Innovation Awards will provide funding for up to three years to projects in a number of targeted areas. As well, the State Innovation Model provides funding to help states design and test improvements to their public and private healthcare payment and delivery systems.

USA - United States of America. Health systems in transition, 2013

This analysis of the United States health system examines the system's organization, governance, financing, physical and human resources and presents health reforms currently underway and an assessment of the health system in the US.

USA - Health Care in the Two Americas: Findings from the Scorecard on State Health System Performance for Low-Income Populations, 2013

This scorecard from the Commonwealth Fund identifies opportunities for states to improve their health systems for economically disadvantaged populations and provides state benchmarks of achievement. Analyzing 30 indicators of access, prevention and quality, potentially avoidable hospital use, and health outcomes, the scorecard documents sharp healthcare disparities among states.

USA - Improving Value in Graduate Medical Education

The Council on Graduate Medical Education (COGME) has issued a report calling for greater value in American graduate medical education (GME), which it says suffers from moribund funding levels, mechanisms and training requirements. The COGME report wants to move GME into ambulatory and community settings and expand the training pipeline.

USA - Regional health care planning: a methodology to cluster facilities using community utilization patterns

The authors of this study, published in BMC Health Services Research, offer a new methodology that clusters facilities based on similarities in patient utilisation patterns and geographic location. This approach may improve the effectiveness of community-based healthcare planning and regulation.

USA - Federal and State Policy to Promote the Integration of Primary Care and Community Resources

This document from the National Academy for State Health Policy in the US presents key themes that emerged from a consultation held with state and federal officials on potential measures each level of government could take to promote linkages between primary care and community services.

USA - New Study Challenges Conventional Wisdom on Pay-for-Performance Incentive Programs

Two new studies published on September 19, 2013, by Robert Wood Johnson Foundation (RWJF) researcher Dr. R. Adams Dudley, suggest that for pay-for-performance incentives to be effective, they must be carefully targeted and designed. The first study tests the effectiveness of incentives for small medical practices that have implemented electronic health records (EHRs). The second focuses on how incentives should be distributed to achieve maximum effect—to individual clinicians, to their practices, or to both.

USA - New Models of Primary Care Could Ease U.S. Physician Shortage

According to a RAND Corporation study, the US primary care physician shortage could be nearly eliminated if the country increased its use of care models expanding the roles of nurse practitioners and physician assistants. Achieving this goal may require policy changes, such as laws expanding scope of practice, along with shifts in the social attitudes of providers and patients.

USA - Medicare Hospital Readmissions Reduction Program. To improve care and lower costs, Medicare imposes a financial penalty on hospitals with excess readmissions

Hospitals with high readmission rates may also offer low quality care. This article analyzes the US Medicare Hospital Readmissions Reduction Program (HRRP), which gives hospitals an incentive to lower readmission rates by financially penalizing institutions with high rates. Some critics of HRRP fear the program will have unintended consequences and threaten care for vulnerable populations.

USA - The Impact of Conformance and Experiential Quality on Healthcare Cost and Clinical Performance

The authors of this working paper, published by the Harvard Business School, examine the relationships between conformance and experiential quality and two important dimensions of hospital performance: cost efficiency and clinical outcomes. They find that hospitals with high levels of both conformance and experiential quality demonstrate better clinical outcomes as measured by length of stay and readmissions, but have worse performance with regard to cost efficiency.

USA - Groundbreaking NYC public health pioneer prescribes remedy for Canada's health woes

Speaking at the October 2013 Canadian Cardiovascular Congress in Montreal, New York City’s Health Commissioner has called on Canada to introduce public health regulations similar to measures in New York City. New York has introduced trans-fat bans and menu calorie labelling requirements in restaurants, limited serving sizes of sugary drinks, and enacted laws prohibiting smoking in public spaces.

USA - The Evolving Role of Emergency Departments in the United States

This RAND Corporation project was performed to develop a more complete picture of how emergency departments (EDs) contribute to the US health care system. It explores the evolving role that hospital EDs play in evaluating and managing complex and high-acuity patients, serving as the major portal of entry to inpatient care, and providing “the safety net of the safety net” for patients who are unable to get care elsewhere.

USA - State Studies Find Home and Community-Based Services to Be Cost-Effective

Many American states have conducted studies to ensure that home and community-based services for low-income people are cost-effective. This report from the AARP Public Policy Institute provides a summary of relevant state studies published between 2005 and 2012, along with web links.

USA - HHS announces 2013 agenda to bring down costs and improve quality of care through implementation of health information technology

The US Department of Health and Human Services (HHS) has announced a new agenda to accelerate health information exchange (HIE) and build a secure flow of information across the system. The HHS will emphasize interoperability, implement new rules on data exchange, ensure program security, and work to enhance the effective use of electronic health records.

USA - How Colorado, Minnesota, and Vermont Are Reforming Care Delivery and Payment to Improve Health and Lower Costs

Colorado, Minnesota, and Vermont are pioneering innovative health care payment and delivery system reforms. While the states are pursuing different models, all three are working to align incentives between health care payers and providers to better coordinate care, enhance prevention and disease management, reduce avoidable utilization and total costs, and improve health outcomes. This synthesis describes the common drivers of reform, lessons learned, and opportunities for federal administrators to support expansion of promising state initiatives.

USA - A Bipartisan Rx for Patient-Centered Care and System-Wide Cost Containment

This report from the Bipartisan Policy Center (BPC) Health Care Cost Containment Initiative provides recommendations for containing rising US healthcare spending while improving the quality and affordability of care. The report’s recommendations are aimed at improving the delivery and financing of healthcare in both the public and private sectors. They span four broad categories: Medicare, tax policy, quality, and payment reform.

USA - Achieving the Potential of Health Care Performance Measures

In this report, the Robert Wood Johnson Foundation recommends how to develop better performance measures and how to ensure the comparability of publicly-reported performance measure data. It recommends, among other things, moving decisively from measuring processes to measuring outcomes and using measurement to promote rapid-learning health care systems.

USA - Lower Mortality in Magnet Hospitals

Magnet hospitals are hospitals recognized for nursing excellence. This study compared 56 Magnet hospitals with 508 non-Magnet hospitals and found lower risk-adjusted mortality rates in Magnet hospitals. This is attributed to high quality standards and positive organizational behaviour.

USA - Bending the Curve: Person-Centered Health Care Reform. A Framework for improving care and Slowing Health care cost Growth

This report from the Brookings Institute proposes a patient-centred framework for healthcare reform as the best way to improve care and contain costs. The report proposes aligning reforms in provider payment, benefit design, regulation, and health plan payment and competition to produce an estimated $300 billion in savings over the next decade.

USA - MEDICAID: Alternative Measures Could Be Used to Allocate Funding More Equitably

The US Government Accountability Office (GAO) has released a study of measures it seeks to use to allocate Medicaid funding to US states more equitably than the current funding formula based on per capita income. The GAO's analysis shows that measures of state resources, demand for services, and geographic cost differences provide a basis for allocating funds more equitably.

USA - Improving Health While Reducing Cost Growth: What is Possible?

Published by the Brookings Institute, this report examines three strategies for avoiding wasteful spending in healthcare delivery and population health improvement. The three strategies are: reforming provider payment systems; enhancing competition to increase consumer incentives; and developing a culture of prevention. The report identifies successful examples of each, and provides simulations of changes in health spending associated with implementation.

USA - Proposed health IT strategy aims to promote innovation, protect patients, and avoid regulatory duplication

The US Department of Health and Human Services (HHS) has released a report proposing a health information technology (health IT) framework that promotes product innovation while maintaining patient protections and avoiding regulatory duplication. The report recommends clarifying the oversight of health IT to focus on product function and patient risk.

USA - The 10 Building Blocks of High-Performing Primary Care

This article by US researchers describes the 10 building blocks of high-performance primary care. They include four foundational elements: engaged leadership, data-driven improvement, empanelment (linking a patient with a care team) and team-based care. These support the implementation of six other elements — patient-team partnership, population management, care continuity, access, coordination, and a template for future care.

USA - County Health Rankings & Roadmaps 2014

County Health Rankings uses available data to measure the overall health of each county in the 50 US states. The roadmaps that accompany the rankings describe corresponding preventative and public health measures. The 2014 version includes comparisons between the healthiest and least healthy counties in the US.

USA - Aiming Higher: Results from a Scorecard on State Health System Performance, 2014

The Commonwealth Fund’s 2014 Scorecard assesses US states on 42 indicators of healthcare access, quality, costs, and outcomes between 2007 and 2012, a period that includes the last recession and precedes the expansion of insurance coverage under Obamacare. Changes in health system performance were mixed, with states making progress on some indicators but losing ground on others.

USA - Health, United States, 2013

The Centers for Disease Control (CDC) have released their 2013 report on Americans’ health. The annual report compiles state and federal health data, and includes summaries of key recent findings. The report has a special section on prescription drug use. About half of all Americans in 2007-2010 reported taking one or more prescription drugs in the past 30 days, the most common being cardiovascular and cholesterol-lowering drugs. Among people under 65, the most commonly used prescription drugs were analgesics and antidepressants.

USA - Investing in America's Health 2014. A State-by-State Look at Public Health Funding and Key Health Facts

In this study, the Trust for America’s Health (TFAH) examines public health funding and key health facts in the 50 US states. The study recommends ways to assure accountability in state funding systems, and suggests measures to improve public health efficiencies in budgeting and administration.

USA - New HHS data show quality improvements saved 15,000 lives and $4 billion in health spending

The Department of Health and Human Services (HHS) has announced a 9% decrease in US hospital-acquired conditions during 2012. Reductions in adverse drug events, infections, falls, and other forms of harm are estimated to have prevented 15,000 hospital deaths, and saved $4 billion in health spending.

USA - Controlling Health Care Spending: Can Consensus Drive Policy?

American strategies to contain healthcare costs have prompted a move away from the fee-for-service payment model. This article reviews alternative cost-containment approaches developed by 10 US health policy organizations and coalitions. It identifies barriers to effective strategies and argues in favour of consensus-driven policies that pinpoint specific areas for spending controls.

USA - Do Integrated Health Care Systems Provide Lower-Cost, Higher-Quality Care?

Obamacare has introduced accountable care organizations (ACOs) based on integrated delivery system (IDS) models as a way to reduce costs and improve care through better service integration. This article analyzes the costs and quality of care provided by 52 Midwestern ACOs using IDS practices. Results show important variations in the costs of care provided by different medical groups serving local communities.

USA - Use and Characteristics of Electronic Health Record Systems Among Office-based Physician Practices: United States, 2001–2013

This briefing note from the National Center for Health Statistics (NCHS) describes the use of electronic health records (EHR) from 2000 to 2013 among US physician practices. In 2013, 78% of office-based physicians used EHR systems, up from 18% in 2001. Adoption of specific EHR systems varied widely across American states.

Lunch hour conferences 2014

By Jean-Pierre Ménard, lawyer Christine Lavoie Patricia Lavoie, Direction des affaires juridiques Ministère de la Santé et des Services sociaux Monique St-Pierre, Direction des services hospitaliers et des affaires universitaires Ministère de la Santé et des Services sociaux The Act respecting end-of-life care, adopted on June 10th 2014, is in line with the unanimous recommendations of the Select Committee on Dying with Dignity and is based on the values of solidarity, compassion and respect for individual wishes. This Act follows three objectives to frame palliative care, to allow medical aid in dying in certain special and exceptional situations, and to establish an advance medical directives regime. This conference will explain why this Act was created. Indeed, the Act respecting end-of-life care is part of a social and legal context. This environment is characterized by the medicine progress, but also by the state of practices (advance wishes, rights and obligations of…

USA - Vice President Biden Announces $100 Million to Increase Access to Mental Health Services

As part of the US Administration’s ongoing commitment to help individuals experiencing mental health problems, on December 10, 2013, Vice President Biden announced that $100 million will soon be available to increase access to mental health services and improve mental health facilities. The expansion of behavioural health services at community health centres and provision of additional services in rural areas are key priorities for the new funding.

USA - National Health Spending Growth Remains Low for 4th Consecutive Year

The Centers for Medicare & Medicaid Services (CMS) has released a report showing that overall US health expenditures grew at an annual rate of 3.7% in 2012, marking four consecutive years of low growth. The report concludes this trend is driven by slower growth in spending on prescription drugs, nursing homes, private health insurance and Medicare.

USA - Is This Time Different? The Slowdown in Healthcare Spending

The National Bureau of Economic Research (NBER), in this report, attributes a 10-year slowdown in US healthcare spending to increases in high-deductible insurance plans, the control of Medicaid costs, and slow growth in the diffusion of new technology. However, the report estimates US healthcare costs will grow more robustly over the next two decades at a rate equalling GDP growth plus 1.2%.

USA - HHS strengthens patients’ right to access lab test reports

As part of an ongoing effort to empower patients, the US Department of Health and Human Services (HHS) has taken action to give patients direct access to completed laboratory test reports. Under new privacy rules, patients are now able to see previously protected health information, including electronic copies of lab reports.

USA - Small Ideas for Saving Big Health Care Dollars

In 2012, American healthcare spending was $2.8 trillion. Rather than focus on large, controversial ideas for reducing expenditures, this RAND Corporation paper explores a collection of 14 specific approaches that individually generate modest cost savings. Approaches include substituting lower-cost treatments and implementing cost-effective preventative patient safety measures.

USA - Patients Are Loyal to Their Doctors, Despite Performance Scores

A new study reveals that US patients selecting a doctor for a first-time visit were likely to choose someone highly ranked by insurance companies, whereas patients who already had a doctor were unlikely to switch to more highly-rated physicians. The study compared information on 171,581 patients who were in a tiered Massachusetts physician network that ranked quality, performance and health plan efficiency.

USA - mHealth in China and the United States: How Mobile Technology is Transforming Health Care in the World’s Two Largest Economies

Rising costs, unequal access and aging populations are increasing pressure on many countries’ healthcare systems. This article suggests that policy-makers look to the US and China, where mobile health technology, or mHealth, is boosting productivity, encouraging better data collection and analysis, and helping providers improve affordability, access and treatment. The authors suggest a number of ideas to speed the international adoption of mHealth.

USA - The Launch of Health Reform in Eight States: State Flexibility Is Leading to Very Different Outcomes

This paper by the Urban Institute provides a review of a series of papers that examine early implementation of the Affordable Care Act in 8 states. These states – Alabama, Colorado, Maryland, Michigan, Minnesota, New York, Oregon, and Virginia – have made very different design choices in implementing the law in everything from information technology systems to enrolment assistance. The authors conclude that the law will work very differently for residents in different states around the country and there will be different outcomes both in terms of coverage and economic impacts.

USA - Implementing the Affordable Care Act. The State of The States

According to this new study, the 50 American states have implemented the 2010 Affordable Care Act in very different ways. The 10 states that have done the most to enforce “Obamacare” — California, Colorado, Connecticut, Hawaii, Maryland, Massachusetts, Minnesota, New York, Oregon and Vermont — have all set up insurance marketplaces, expanded Medicaid coverage, and enacted insurance reforms that benefit consumers.

USA - Nurse Practitioners and Their Effects on Visits to Primary Care Physicians

In the US, a shortage of primary care physicians has led to calls for expanding the roles of allied health professionals. This study examined the effects of visits to nurse practitioners on the demand for primary care physician services. Results indicated that patients who visit a nurse practitioner are less likely to receive medical check-ups, diagnosis and medication from primary care physicians.

USA - Decomposition of the drivers of the U.S. hospital spending growth, 2001-2009

In this study, researchers describe the trend in total hospital spending, price, and quantity between 2001 and 2009 in the US. They find that high hospital spending appears to be driven by higher payment per unit of hospital output, not by increased utilization. The study appeared in BMC Health Services Research.

USA - HHS announces $685 million to support clinicians delivering high quality, patient-centered care

On September 29, 2015, the US Department of Health and Human Services (HHS) announced $685 million in awards to equip over 140,000 clinicians with the tools and support to improve quality of care. The new initiative is one of the largest federal investments supporting clinicians and patient-centred care through peer-based, collaborative learning networks.

USA - Hospital-community partnerships to build a culture of health: a compendium of case studies

Published by the American Hospital Association (AHA), this collection of case studies discusses 10 hospital-community partnerships established in different locations and service types, and their joint initiatives to build a Culture of Health where all individuals have equal opportunities for optimum health. The case studies highlight the wide variety of effective, sustainable strategies and programs in specific local contexts.

USA - Meaningful Use legislation led to a 'substantial change' in EHR adoption

This study finds that an incentive program established under the federal 2009 HITECH Act has substantially increased electronic health record (EHR) adoption by American hospitals. The authors say the so-called Meaningful Use legislation could serve as a model to influence health technology adoption in the future.

USA - A Roadmap for Promoting Health Equity and Eliminating Disparities

The National Quality Forum (NQF) has created a roadmap to reduce US health disparities through performance measurement and policy levers. Focused on cardiovascular and kidney disease, cancer, diabetes, infant mortality and mental illness, the roadmap prioritizes identifying disparities and implementing interventions, making investments in assessment measures, and providing incentives to reduce disparities.

USA - Follow the evidence - Care Continuum Optimization can minimize clinical variation to drive real quality in healthcare

This paper describes a care quality model called Care Continuum Optimization (CCO), which minimizes clinical variation to improve performance across the care continuum. The model involves clinical care redesign supported by data analysis, care management, and governance models managing provider accountability. Improvements are achieved through management of operational, financial, and clinical data. Advanced data and analytics are vital for identifying areas for process improvement.

USA - The Impact of Primary Care Practice Transformation on Cost, Quality, and Utilization

This evidence report from the Patient-Centered Primary Care Collaborative (PCPCC) highlights findings from 45 newly released peer-reviewed reports and additional government and state evaluations. It finds the patient-centered medical home (PCMH) and other forms of advanced primary care show improved outcomes in many studies.

USA - Health Care Quality Continues to Improve, But Disparities Persist

According to a new report, the quality of American health care has improved steadily since 2000, with notable gains occurring in patient safety. However, disparities in care have not improved. Hospital visits for mental health care, for example, have increased among the poor — from 1,400 per 100,000 in 2007 to 2,000 per 100,000 in 2014.

USA - National Health Care Spending in 2016

New research shows that American healthcare spending increased by 4.3% in 2016, reaching $3.3 trillion. The share of GDP devoted to health care is now 17.9%. However, US health spending is now decelerating after growth in previous years associated with coverage expansions under the Affordable Care Act (ACA).

USA - Leading a Culture of Safety: A Blueprint for Success

This guide was developed to provide healthcare leaders a tool for assessing and advancing their organization’s culture of safety. It can be used to help determine the current state of an organization’s journey; inform dialogue with the boards and leadership teams; and help leaders set priorities. The guide contains both high-level strategies and practical tactics.

USA - Aiming Higher: Results from the Commonwealth Fund Scorecard on State Health System Performance 2017 Edition

The 2017 edition of this scorecard finds that health systems in nearly all US States improved on a broad array of health indicators between 2013 and 2015. During this period, the proportion of people without insurance fell, and more people were able to access needed care, particularly in states that expanded Medicaid programs. On a less positive note, premature death rates rose slightly between 2011 and 2014.

USA - NAM Releases Publication on How to Improve Nation's Health System

This paper from the National Academy of Medicine presents a policy framework for US health system improvement. It describes eight actions and infrastructure priorities to significantly advance American health, health care, and science. This publication is part of the National Academy of Medicine’s Vital Directions for Health and Health Care Initiative, which called on more than 150 leading researchers, scientists, and policy makers from across the United States to assess and provide expert guidance on 19 priority issues for U.S. health policy.

USA - Next Generation of Community Health

The American Hospital Association (AHA) 2016 Committee on Research was charged with exploring what the next generation of community health may look like as hospitals redefine themselves to keep pace with the changing health care landscape. This report presents the committee's work, reviews US community health trends and results, and proposes collaborative strategies.

USA - State Policy Capacity and Leadership for Health Reform

The aim of the study was to understand how policy capacity was defined and managed by state health leaders in different political environments during the implementation of the ACA. The authors of the study have developed a capacity checklist for policymakers to use as they embark on new health reform initiatives.

USA - Lessons from States on Advancing Evidence-based State Health Policymaking for the Effective Stewardship of Healthcare Resources

Published by the National Academy for State Health Policy (NASHP), this briefing provides US states with actionable information on evidence-based policymaking. It describes why states should work with evidence, and presents key considerations for developing an evidence-based policymaking process, along with strategies for engaging patients and consumers.

USA - Deep Inequities Exist in States’ Preparedness for Public Health Emergencies, 2017 Index Shows

The Robert Wood Johnson Foundation (RWJF) has released the results of the 2017 National Health Security Preparedness Index, an annual assessment of the 50 US states’ preparedness for community health emergencies. Significant inequities in preparedness continue to exist, with states in the American south and west lagging behind northeast and Pacific coast states.

USA - US experience with Accountable Care Organizations: lessons for France?

This article, published in the April issue of Questions d'économie de la Santé, examines the rapid spread of Accountable Care Organizations (ACO) in the United States following the adoption of the Affordable Care Act in 2010. ACOs strengthen primary care and promote coordination between primary care and hospital. More than 800 ACOs are now registered and cover 15% of US policyholders. Presenting a review of the literature, the article describes the characteristics of ACOs, their performance, and the tools and approaches they mobilize.

UK - New approach to NHS clinical assessment could save thousands of lives

The National Health Service (NHS) in England is asking hospital organizations to adopt a new clinical assessment system that could save thousands of lives every year. The National Early Warning Score (NEWS) assesses patients using key health measures that reflect the level of clinical care the patient needs, along with their risk of deterioration.

USA - NIH releases strategic plan for data science

The National Institutes of Health (NIH) released its first strategic plan for data science as it seeks to upgrade the storage, management, and standardization of data produced by NIH-funded biomedical data scientists. The strategy will address the interoperability, integration and increasing cost of data management, and introduce a new position of NIH Chief Data Strategist.

USA - Accounting for the Rise of Health Spending and Longevity

This study by Québec researchers investigates the rise of health spending and longevity in the US over the period 1965-2005. It estimates that technological change and more generous health insurance explain 36% of the health-spending rise. Technological change, taking the form of increased healthcare productivity, explains most of the rise in life expectancy over the study’s 40-year period.

USA - 2018 Scorecard on State Health System Performance

The US states of Hawaii, Massachusetts and Minnesota are this year’s top-ranked performers in the 2018 Scorecard on State Health System Performance. The scorecard assesses 40 measures of access to health care, quality of care, health outcomes, and income-based disparities. The scorecard also reveals that 28 states are losing ground on measures related to life expectancy.

USA - Nurse Practitioner–Physician Comanagement: A Theoretical Model to Alleviate Primary Care Strain

American nurse practitioners (NPs) are increasingly managing patient care as clinicians. This paper surveys 156 prior studies to develop a new model of clinical co-management between NPs and physicians. The model has three elements: effective communication, mutual respect, and clinical alignment of care. The paper also describes the legal and organizational barriers that continue to inhibit NP practice in the US.

USA - Access Management in Primary Care. Perspectives from an Expert Panel

Undertaken by an expert panel of patients, providers, policymakers, purchasers, researchers, product makers and payers, this Rand Company report defines optimal access in primary healthcare organizations and identifies eight priorities for improving access. First among them is routinely evaluating the degree to which patient telephone calls are answered promptly and routed appropriately.

USA - Hospital Rating Tools Should Allow Patients to Customize Rankings to Meet Their Individual Needs

A RAND Corporation analysis appearing in the New England Journal of Medicine (NEJM) argues that hospital rating and ranking tools should be modified to include quality measures that reflect individual needs. Modelling shows that hospital quality reports tailored to the ‘average’ patient are not a good fit for most people under care.

USA - Advanced Primary Care: A Key Contributor to Successful ACOs

This evidence report from the Patient-Centered Primary Care Collaborative (PCPCC) examines the contribution of patient-centred medical homes (PCMHs) to the success or failure of accountable care organizations (ACOs) using both qualitative and quantitative methods. The qualitative analysis involved two literature reviews and input from an expert committee. Quantitative analysis is based on the 2014 Medicare Shared Savings Program (MSSP) data set. The authors find interdependence between PCMHs and ACOs in improving population health and lowering costs.

USA - Leaning in to Succeed in Public Hospitals

Lean has been written about extensively as a philosophy and management system embedded in a culture of continuous improvement. This article looks at lessons learned from Lean’s application within two California public hospitals in the San Francisco area. It stresses that Lean methodologies are most successful when staff at all levels commit to them, and that Lean processes can take years to fully implement.

USA - Approaches to Cross-Sector Population Health Accountability

The US is the only developed country to spend more on health care than on social services, suggesting that opportunities to address non-clinical health risk factors go unanswered. Financial alignment across the two sectors is one promising strategy to encourage collaboration and improve population health. This paper proposes a framework for defining risk relationships and outlines two approaches for aligning incentives: parallel risk and hierarchical risk.

USA - The History, Evolution, and Future of Medicaid Accountable Care Organizations

Increasingly prevalent in the United States, accountable care organizations (ACOs) shift more accountability for health outcomes to providers and have shown positive results improving care and reducing costs for government programs like Medicaid. This brief highlights Medicaid ACO programs in 12 American states and examines their evolution over time. It highlights that developing and operationalizing state-wide programs can be a complex undertaking.

USA - What are effective approaches for recruiting and retaining rural primary care health professionals?

AcademyHealth undertook this review of 15 interventions to improve the recruitment and retention of primary care health professionals in rural areas. After synthesizing evidence on effectiveness, the review found that few of the individual approaches examined had positive effects on both recruitment and retention, and that combining interventional approaches may be a more effective way to expand and maintain the rural primary care workforce.

USA - Partnering to Succeed. How small health centers can improve care and thrive under value-based payment

In the US, small health centres (those with fewer than 10,000 patients or an annual budget of $10 million or less) face unique challenges in securing capital, building strong data capabilities, negotiating favourable rates with vendors, and securing contracts with health plans. This paper investigates seven types of partnerships for small health centres and reviews the advantages and disadvantages of each partnership type.

USA - How can healthcare organizations implement patient-centered care? Examining a large-scale cultural transformation

Seeking to understand key organizational factors for implementing patient-centred care, authors of this study conducted interviews with 108 employees of four US Department of Veterans Affairs medical centres. Actions found to foster patient-centred care were grouped by the investigators into seven domains: leadership; patient and family engagement; staff engagement; focus on innovations; alignment of staff roles and priorities; organizational structures and processes; and environment of care.

USA - New Research Shows Increasing Physician Shortages in Both Primary and Specialty Care

In a report published on April 11, the Association of American Medical Colleges states that the US could see a shortage of between 42,000 and 121,000 physicians by 2030. These findings persist despite modeling that takes into account the use of other health professions and changes in the delivery of care. Population growth and aging are major factors in the anticipated shortage, notable the aging of physicians: the number of physicians over age 65 will increase by 50% by 2030.

USA - New County Health Rankings Show Differences in Health and Opportunity by Place and Race

The 2017 edition of County Health Rankings finds that health gaps persist not only by location, but also by race and ethnicity in the US. Data shows that minority communities are more likely to be cut off from opportunities for health, while burdens of poverty continue to fall heaviest on children of colour.

USA - Value Frameworks: Value in Health Special Issue

The new issue of Value in Health includes seven papers that comprise the ISPOR Special Task Force Report on US Value Assessment Frameworks. The papers provide an introduction to value frameworks and then define elements of value, discuss opportunity costs and thresholds, present a review of existing frameworks, and outline a set of best practice recommendations.

USA - Digital Health Innovation Super-Utilizer Challenge: Themes and Lessons

Although the market for digital health tools is flourishing, few products are designed to meet the needs of low-income, high-need, high-cost patients. To address this market gap, in early 2015 the Center for Health Care Strategies (CHCS) held a national Super-Utilizer Health Innovation Challenge to demonstrate the viability of products designed for this population. This report summarizes themes and lessons from the Challenge.

USA - The Patient-Centered Medical Home’s Impact on Cost and Quality. Annual Review of Evidence 2014-2015

The Patient-Centred Primary Care Collaborative (PCPCC) is an American primary care delivery initiative that emphasizes a 'medical home' approach to improve patient-centred care while reducing care costs. This 2015 evidence review provides a summary of 'medical home' cost and utilization results from studies, industry reports, and government evaluations.

USA - 2016 County Health Rankings Key Findings Report

Ranking the health of the 3,143 counties in the US, this annual report finds that the rate of opioid drug overdoses has increased 79% nationally since 2002. Rural counties have the highest rates of overall premature deaths, while residential racial segregation remains the leading cause of health disparities across the country.

USA - Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care

The field of behavioural economics is built on the premise that human behaviour is not always rational. This study focuses on principles relevant to influencing physician practice patterns and performance, such as loss aversion, choice overload, and relative social ranking. The authors argue that physicians’ monetary incentive programs should account for how emotions and social status, among other variables, factor into provider decisions.

USA - Models of care for high-need, high-cost patients: an evidence synthesis

This briefing note analyzes evidence reviews of 15 care models to improve outcomes and reduce costs for patients with complex needs. Overall, the brief finds only modest evidence of impact. It notes that few models have been adopted in practice because of barriers, including the lack of supportive financial incentives under fee-for-service reimbursement arrangements.

USA - Maine’s Health Care Reform Law is Helping Business

This study from the Maine Heritage Policy Center looks at Maine’s new health care reform law (PL90) and highlights the practical impact it is having on end users: the businesses and consumers who purchase private health insurance in Maine. PL90 contained numerous provisions aimed at improving Maine’s individual and small group health insurance markets.

USA - U.S. Health Care from a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries

Comparing US healthcare spending, supply, utilization, prices, and health outcomes with 13 other high-income countries, this analysis of data from the OECD shows that the US outspends the rest by a large margin. Americans also had the poorest health outcomes, including the shortest life expectancy and a greater prevalence of chronic conditions.

USA - HHS Awards More Than $240 Million to Expand the Primary Care Workforce and Connect Health Care Professionals to Underserved Communities

The US Department of Health and Human Services (HHS) has committed $240 million to further support National Health Service Corps (NHSC) and Nurse Corps loan repayment programs. Over 9,600 NHSC primary care medical, dental and mental health practitioners and 2,000 Nurse Corps nurses are provided funding in exchange for service in underserved communities.

USA - Future Pandemics Pose Massive Risks to Human Lives, Global Economic Security, Says New Report

Infectious disease pandemics can kill millions of people and cause losses of trillions of dollars, says a new report from the Commission on a Global Health Risk Framework for the Future. The Commission estimates that economic losses from potential pandemics could amount to $60 billion per year, and recommends an annual global investment of $4.5 billion to enhance prevention, detection, and preparedness.

USA - National patient safety efforts save 87,000 lives and nearly $20 billion in costs

This report by the Department of Health and Human Services (HHS) estimates that 87,000 fewer US hospital patients died and nearly $20 billion in healthcare costs were saved as a result of a reduction in hospital-acquired conditions between 2010 and 2014. The data shows demonstrable progress in improving patient safety in hospital settings.

USA - Systems Practices for the Care of Socially At-Risk Populations

Since 2010, US Medicare and Medicaid services have been moving to value-based payments (VBPs) that include incentive programs and risk-based alternative payment models. This article discusses evidence from these programs showing that providers serving patients with social risk factors for poor health outcomes are more likely to fare poorly on quality rankings and are less likely to receive financial rewards.

USA - The Impact of Adding a Physician Assistant to a Critical Care Outreach Team

Hospitals use critical care outreach teams (CCOTs) to respond to patients outside intensive care units (ICUs) whose condition deteriorates. This study assesses whether adding a Physician Assistant (PA) to a CCOT improves clinical and process outcomes. Findings show that adding a PA to the CCOT is associated with a notable reduction in time-to-transfer to the ICU; hospital mortality and length of stay are not impacted.

USA - Government Spending In Health and Nonhealth Sectors Associated With Improvement In County Health Rankings

Using census data, this study measures the impact of community health and non-health expenditures on a broad measure of overall health, the US County Health Rankings (CHR). The authors of the study found significant positive associations between expenditures and County Health Rankings for seven of the fourteen expenditure categories examined: community health care and public health, public hospitals, fire protection, K–12 education, corrections, libraries, and housing and community development.

USA - In New Survey of 11 Countries, U.S. Adults Still Struggle with Access to and Affordability of Health Care

An 11-country survey has found that US citizens are the most likely to go without needed health care because of cost factors. Americans are also more likely to report having poor health and emotional distress. Bright spots for US health care include collaborative hospital discharge planning and access to specialist care.

USA - Health and Wellness Programs for Hospital Employees: Results from a 2015 American Hospital Association Survey

The American Hospital Association (AHA) surveyed US hospitals in 2015 to identify current and emerging best practices in health and wellness programs for hospital employees. This report presents results from the survey, showing that almost 87% of hospitals now have employee health and wellness programs, with 31% experiencing participation rates of over 90%.

USA - HHS selects eight states for new demonstration program to improve access to high quality behavioral health services

The Department of Health and Human Services (HHS) has selected eight US states for a Certified Community Behavioural Health Clinic (CCBHC) demonstration program aimed at improving community health services. The project is part of an effort to integrate behavioural and physical health care and improve access to care for people with mental and substance use disorders.

USA - Cardiovascular disease costs will exceed $1 trillion by 2035

In this report, released on Valentine's Day, the American Heart Association predicts that 45% of the total US population will have cardiovascular disease (CVD) by 2035. The Association calls for action on prevention and maintaining health coverage by protecting the ban on pre-existing conditions. In 2015, 100 million Americans were suffering from CVD, imposing high direct and indirect costs in terms of treatment and lost productivity.

USA - A Framework for Safe, Reliable, and Effective Care

This white paper from the Institute for Healthcare Improvement describes the framework's two foundational domains: culture and the learning system. The paper defines key strategies for developing leadership, psychological safety, accountability, teamwork and communication, negotiation, transparency, reliability, improvement and measurement, and continuous learning. It further discusses the engagement of patients and families as the engine that drives progress toward safe and effective care.

USA - Rising to the Challenge. The Commonwealth Fund Scorecard on Local Health System Performance, 2016 Edition

Assessing 36 indicators of access, quality, avoidable hospitalization, cost and outcomes across 306 local health systems, this report finds wide variation in health and healthcare across American communities. Overall, health care improve in the period observed (2013-15), and improvement often corresponded to public policy implementation, notably the Affordable Care Act ("Obamacare").

USA - Improving the Health Care System: Seven State Strategies

State legislatures play an important role in cutting healthcare waste and improving health systems. This briefing note from the National Conference of State Legislators (NCSL) describes healthcare improvement strategies showing results in Connecticut, Hawaii, Massachusetts, Minnesota, New Hampshire, Rhode Island and Vermont. The state strategies highlight new payment models, patient-centred integrated care, reliance on data, and investments in prevention and safety.

USA - What Does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics

This Harvard paper examines consumer responsiveness to healthcare pricing via a case study of a self-insured firm that switched from a free employee healthcare plan to a high deductible plan that saved the company $100 million per year. The paper uses the case data to examine consumer response to the new high-deductible contract and investigate its impact on healthcare prices, quantity, and spending dynamics.

USA - The Impact of Establishing a Full Scope of Practice for Nurse Practitioners in Michigan

Michigan state regulations treat Nurse Practitioners (NPs) like registered nurses (RNs), limiting their scope of practice (SOP). This paper examines associations between state NP and SOP regulations and healthcare delivery outcomes, and estimates the impact in Michigan if the SoP of NPs were expanded. The authors conclude that this would improve access to care.

USA - Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences

This study analyzes data from the 2009–2011 Medical Expenditure Panel Survey to compare the healthcare experiences of high-need adults with those of other adults. The study finds that adults with three or more chronic diseases reported unmet medical needs most often and were less likely to experience good patient–provider communication. Privately insured high-need adults reported the greatest difficulties in having their needs met.

USA - Strengthening Primary and Chronic Care: State Innovations to Transform and Link Small Practices

This report examines the roles states are playing to reorganize the delivery of primary and chronic care to produce more efficient and effective care for patients and providers, particularly in small practices. Through short case studies developed via interviews with state officials and physicians in Colorado, Michigan, North Carolina, Oklahoma, Pennsylvania, and Vermont, the authors highlight several state-based initiatives that seek to create high-performing health systems by targeting local and regional strengths.

USA – Healthy people 2020 - The nation’s new health promotion and disease prevention agenda

The U.S. Department of Health and Human Services recently unveiled Healthy People 2020, the nation’s new 10-year goals and objectives for health promotion and disease prevention. For the past 30 years, Healthy People has been committed to improving the quality of the Nation’s health by producing a framework for public health prevention priorities and actions.

USA - It is time to talk about people: a human-centered healthcare system

The authors of this article propose that a robust and sustainable healthcare system must be human-centered. Efforts to build and rebuild parts of the system in a human centered fashion require reliable tools. Two of these tools that are currently underutilized in the area of healthcare are a) Reason’s system approach and b) User-centered design. As a call for more human-centered approaches to optimizing healthcare delivery, they review these two approaches, using a variety of examples to illustrate both real and potential applications.

USA - Family Medicine Releases Issue on Rural Health

Throughout the history of the specialty, family medicine programs have graduated physicians that are capable and willing to provide health care to underserved populations. This issue of Family Medicine, dedicated to rural health education, celebrates that accomplishment by showcasing family medicine programs and educational strategies designed to produce high-quality rural family physicians.

USA - HHS Releases Report on Americans with Pre-existing Health Conditions

A new analysis released by the Department of Health and Human Services (HHS) shows without the Affordable Care Act, up to 129 million non-elderly Americans who have some type of pre-existing health condition, like heart disease, high blood pressure, arthritis or cancer, would be at risk of losing health insurance or be denied coverage.

USA — For the Public’s Health: The Role of Measurement in Action and Accountability

To inform the public health community and all other sectors that contribute to population health, the Robert Wood Johnson Foundation commissioned the IOM to examine three major topics that influence the health of the public—measurement, laws, and funding. In this, the first of three reports, the IOM reviews current approaches for measuring the health of individuals and communities and suggests changes in the processes, tools, and approaches used to gather information about health outcomes and their determinants.

USA — On the Road to Better Value: State Roles in Promoting Accountable Care Organizations

This report examines the development of the accountable care organization (ACO) model, focusing on Colorado, Massachusetts, Minnesota, North Carolina, Oregon, Vermont, and Washington. The report highlights five key areas in which states have played a role in supporting the development of the ACO model (data, designing and promoting new payment methods, accountability measures, identifying and promoting systems of care, and supporting a continuum of care, including the patient-centered medical home) and is intended to provide state and national policymakers with information that can stimulate further innovation.

USA — State Scorecard on Child Health System Performance, 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.

USA - Realizing Health Reform's Potential: How the Affordable Care Act Will Strengthen Primary Care and Benefit Patients, Providers, and Payers

Although primary care is fundamental to health system performance, the United States has undervalued and underinvested in primary care for decades. This brief describes how the Affordable Care Act will begin to address the neglect of America’s primary care system and, wherever possible, estimates the potential impact these efforts will have on patients, providers, and payers. The health reform law includes numerous provisions for improving primary care: temporary increases in Medicare and Medicaid payments to primary care providers; support for innovation in the delivery of care, with an emphasis on achieving better health outcomes and patient care experiences; enhanced support of primary care providers; and investment in the continued development of the primary care workforce.

USA - Achieving Universal Coverage through Comprehensive Health Reform: The Vermont Experience – Evaluation Results

In 2006, Vermont passed the Health Care Affordability Acts (HCAA) to create universal access to affordable health care, contain costs and improve the quality of care. Five years after comprehensive health reform legislation, the percentage of residents with health care coverage has rapidly increased, as has the take-up of Catamount Health, the public insurance program created under the HCAA. This brief from the State Health Access Reform Evaluation (SHARE) initiative examines these impacts in the context of the Affordable Care Act (ACA), and evaluates the potential implications for national health reform.

USA — More People Get Health Screenings When Deductibles Are Waived

People are more likely to get screened for conditions like cancer and high cholesterol when they don’t have to pay a health insurance deductible reveals a new study in the journal Health Services Research.

USA - AAMC Releases New Physician Shortage Estimates Post-Reform

The AAMC (Association of American Medical Colleges) has released new physician shortage estimates based on projections by the Center for Workforce Studies beginning in 2015 that are 50 percent worse than originally anticipated prior to health care reform. The United States already was struggling with a critical physician shortage and the problem will only be exacerbated as 32 million Americans acquire health care coverage, and an additional 36 million people enter Medicare.

USA — Implementing Health Reform: Federal Rules & State Roles

Implementing the new health reform law falls in large measure to the federal government. But all 50 states and the District of Columbia have responsibilities under the new law. This issue brief describes how some key tasks to be performed by each and how state government implementation efforts will mesh.

USA - Patient-Centered Medical Homes. A new way to deliver primary care may be more affordable and improve quality. But how widely adopted will the model be?

Patient-centered medical homes are considered by many to be among the most promising approaches to delivering higher-quality, cost-effective primary care, especially for people with chronic health conditions. Although there is no single standard definition of a medical home, there is an agreed upon set of principles behind the concept, and most medical homes share common elements. This brief describes recent projects that have applied patient-centered medical home concepts, as well as concerns about widespread adoption of the model before results are definitive.

USA - Determinants of preventable readmissions in the United States: a systematic review

Hospital readmissions are a leading topic of healthcare policy and practice reform because they are common, costly, and potentially avoidable events. The authors of this paper undertook a systematic review of the literature to determine what factors are associated with preventable readmissions.

USA - Performance Measurement in Fee-for-Service Medicaid: Emerging Best Practices

Through support from the California HealthCare Foundation, the Center for Health Care Strategies (CHCS), in collaboration with the California Department of Health Care Services (DHCS), sought to better understand how states are using performance measures for Medicaid FFS beneficiaries, particularly those with complex needs. This resulting report outlines emerging best practices for measuring the quality of FFS care culled from the firsthand experiences of nine states as well as numerous interviews with key stakeholders across the country.

USA - The ABCs of Measurement

This report from the National Quality Forum explains how the science of measuring health care performance is making enormous progress, and continues to evolve. Measures represent a critical component in the national endeavor to assure that all patients receive appropriate and high quality care.

USA – New report shows Affordable Care Act savings of $3,500 for Medicare beneficiaries

A new analysis recently released by the U.S. Department of Health and Human Services estimates that under the Affordable Care Act, average savings for those enrolled in traditional Medicare will amount to more than $3,500 over the next ten years. Savings will be even higher – as much as $12,300 over the next 10 years – for seniors and people with disabilities who have high prescription drug costs.

USA - Latest Report on Nation's Health Released

"Health, United States, 2010," the 34th annual report prepared by CDC's National Center for Health Statistics is now available at The report includes a compilation of health data from state and federal health agencies as well as an in-depth feature section on death and dying.

USA — The Center for Health Care Strategies Launches Online ROI Forecasting Calculator for Health Homes and Medical Homes

The Return on Investment Forecasting Calculator for Health Homes and Medical Home launched recently by the Center for Health Care Strategies (CHCS) is a new web-based tool created to help Medicaid stakeholders evaluate the cost-savings potential of health home and medical home initiatives. CHCS developed this practical tool with support from the Robert Wood Johnson Foundation.

USA — Medicare Launches Quality-Based Payment System for Hospitals

After a decade or so of collecting information from hospitals on the quality of their care, the Medicare program announced recently that it will finally start using what the data actually reveals about a hospital's performance to set the level of payments it receives.

USA — Accountable Care Organizations Have Potential to Curb Costs and Improve Health Care

If implemented successfully, accountable care organizations (ACOs) have the ability to achieve better care, better population health, and lower costs, according to a new report released recently by the Commonwealth Fund Commission on a High Performance Health System. Implementing ACOs effectively will be vital to their success and, to that end, the Commission report also includes 10 recommendations for effective implementation, focusing on the design, payment and functioning of ACOs.

USA — Lessons Learned in Public Reporting: Crossing the Cost and Efficiency Frontier

This brief provides lessons from communities involved in Aligning Forces for Quality, the Robert Wood Johnson Foundation’s signature effort to lift the quality of care in America. Public reporting is a cornerstone of the Aligning Forces for Quality program. This brief focuses on the evolving process of public reporting and the challenges associated with adding cost and efficiency measures to reports of quality performance data.

USA - The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations

This paper in the July 2011 issue of the Commonwealth Fund publication Issues in International Health Policy analyzes 2010 OECD health data for Australia, Canada, Denmark, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Health care spending in the U.S. towers over the other countries and findings suggest opportunities for cross-national learning to improve health system performance.

USA — Care coordination model: better care at lower cost for people with multiple health and social needs

This white paper outlines methods and opportunities to better coordinate care with people with multiple health and social needs, and reviews ways that organizations have allocated resources to better meet the range of needs in this population.

USA — Success Factors in Five High-Quality, Low-Cost Health Plans

In this report, the authors conducted case studies of five health plans that received high scores on quality and resource utilization, using data collected by the National Committee for Quality Assurance. The focus of this study was to understand how health plans with delivery systems that include a significant network of independent, community physicians achieve high performance.

USA — IOM Report Offers 12 Key Indicators and 24 Objectives to Help Focus Healthy People 2020 Efforts to Improve Americans' Health

Healthy People 2020, the U.S. Department of Health and Human Services' master plan for improving the health of the American population over the next decade, covers 42 topics and nearly 600 objectives. A new report from the Institute of Medicine singles out 12 indicators as immediate, major health concerns that should be monitored and 24 objectives that warrant priority attention in the plan's implementation.

USA - Going 'Green' May Cut Hospital Costs

Implementing practical, environmentally friendly practices in operating rooms and other hospital facilities could reduce health-care costs without compromising patient safety, says a new study. In the United States, health-care facilities are a major source of waste products, producing more than 6,600 tons per day and more than 4 billion pounds a year. Nearly 70 percent of hospital waste is produced by operating rooms and labour-and-delivery suites.

USA - HHS Announces $750 Million Investment in Prevention

Department of Health and Human Services Secretary Kathleen Sebelius recently announced a $750 million investment in prevention and public health, funded through the Prevention and Public Health Fund created by the new health care law. Building on $500 million in investments last year, these new dollars will help prevent tobacco use, obesity, heart disease, stroke, and cancer; increase immunizations; and empower individuals and communities with tools and resources for local prevention and health initiatives.

USA — Federal Health Reform: State Legislative Tracking Database

The database includes 2011 legislation, including pending, failed and enacted bills and resolutions. The database is intended to capture state actions related to the Patient Protection and Affordable Care Act and the Health Care Education and Reconciliation Act, together referred to as the Affordable Care Act or federal health reform.

USA — Review of recent studies shows predominantly positive results for health information technology

A study completed by the Office of the National Coordinator for Health Information Technology (ONC) and published in the journal Health Affairs finds growing evidence of the benefits of health information technology (HIT). Using methods that were employed by two previous independent reviews, the new study finds that 92 percent of articles on HIT reached conclusions that showed overall positive effects of HIT on key aspects of care including quality and efficiency of health care.

USA — County Health Rankings Show There is More to Health than Health Care

A new set of reports rank the overall health of nearly every county in the nation. In its second year, the County Health Rankings continue to confirm the critical role that factors such as education, jobs, income, environment and access to health care play in how healthy people are and how long they live.

USA — The 2011 Commonwealth Fund Survey of Public Views of the U.S. Health System

More than seven of 10 adults believe the U.S. health system needs fundamental change or complete rebuilding. Most adults surveyed reported difficulties accessing care, poor care coordination, and struggles with the costs and administrative hassles of health insurance.

USA — Re-Forming Health Care Delivery Systems: A Summary of a Forum for States and Health Centers

In June 2010, the National Academy for State Health Policy (NASHP) convened a forum to examine evolving model approaches as well as surface new strategies that could be promoted with federal and state policymakers, foundations and the health center community to help progression toward reformed health systems. This paper presents the vision laid out at the forum for a transformed delivery system. In addition, it offers specific examples of organizations, regions and states that are designing and implementing approaches aligned with this vision, and outlines the strategies identified by participants as important in moving towards a reformed delivery system.

USA — Driving Value in Medicaid Primary Care: The Role of Shared Support Networks for Physician Practices

The new Commonwealth Fund report prepared by the Center for Health Care Strategies explores how a system of shared supports can help ensure that smaller independent physician practices serving Medicaid patients are able to deliver a full range of medical home services.

USA - The use of medical technology in the United States increased dramatically between 1996 and 2006, according to "Health, United States, 2009"

Health, United States, 2009 is the federal government’s 33rd annual report to the President and Congress on the health of all Americans.The report was prepared by the Centers for Disease Control and Prevention’s National Center for Health Statistics from data gathered by state and federal health agencies and through ongoing national surveys. This year's edition features a special section on medical technology, and finds that the rate of magnetic resonance imaging, known as MRI, and computed and positron emission tomography or CT/PET scans, ordered or provided, tripled between 1996 and 2007.

USA : Shortchanging America's Health. A State-by-State Look at How Public Health Dollars Are Spent

A March 2010 report from the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) found federal spending for public health has been flat for nearly five years, while states around the country cut nearly $392 million for public health programs in the past year. These cuts leave communities around the country struggling to deliver basic disease prevention and emergency health preparedness services.

USA - Reducing Costs through the Appropriate Use of Specialty Services

This white paper describes efforts by the Institute for Healthcare Improvement (IHI) to find ways to reduce overuse, with a focus on specialty services, a significant source of expense in the US health care system. Examples of success in identifying and reducing overuse without apparent negative impact on quality, and without using techniques experienced as coercive by physicians, are explored.

USA - Launch of First County-By-County Health Rankings

The County Health Rankings—the first set of reports to rank the overall health of every county in all 50 states—are now available on The 50-state report, released by the University of Wisconsin’s Population Health Institute and the Robert Wood Johnson Foundation, help public health and community leaders, policy-makers, consumers and others to see how healthy their county is, compare it with others within their state and find ways to improve the health of their community.

USA - Can Cost-Effective Health Care=Better Health Care? Cost-effectiveness research pinpoints best values for limited health care dollars

An interview with Harvard School of Public Health’s Milton Weinstein offers some revealing insights into how the U.S. health care system could save money by focusing on the cost per year of healthy life that each medical intervention provides.

USA - New Online Resource Offers Guide to Health Reform Implementation

George Washington University and Robert Wood Johnson Foundation launch Health Reform GPS, a Web portal that will help key stakeholders understand health reform legislation and make it operational.

USA - Federal Government Will Pick Up Nearly All Costs Of Health Reform’s Medicaid Expansion

Health reform’s critics argue that states will bear a significant share of the new law’s costs for Medicaid expansion, placing an unaffordable financial burden on states. The argument does not withstand scrutiny according to the Center of Budget and Policy Priority. In its first five years, the Medicaid expansion will add just 1.25 percent to what states had budgeted for Medicaid over that period in the absence of health reform, while providing health coverage to 16 million more low-income adults and children.

USA - The Cost of Failure to Enact Health Reform

The number of uninsured Americans could grow by 10 million people in just five years, and spending on government health care programs for the poor could more than double by 2020, if there are not significant reforms to the current health care system, according to a new analysis just released from the Robert Wood Johnson Foundation (RWJF).

USA - Health care expenditure and income in the OECD reconsidered: evidence from panel data

This paper reconsiders the long-run economic relationship between health care expenditure and income using a panel of 20 OECD countries observed over the period 1971-2004.

USA - Health Care Reform. A Collection of Articles on U.S. Health Care Reform

Victor R. Fuchs is the Stanford economics professor who is the dean of American health economists and is best known for his thoughtful book Who Shall Live? In just the past two years he has written 12 short articles that have appeared in such prestigious publications as the Journal of the American Medical Association (JAMA), New England Journal of Medicine and Health Affairs: Eliminating “Waste” in Health Care, Four Health Care Reforms for 2009, Cost Shifting Does Not Reduce the Cost of Health Care, The Proposed Government Health, Insurance Company — No Substitute for Real Reform, Reforming US Health Care – Key Considerations for the New Administration, Health Reform: Getting The Essentials Right, Health Care Reform — Why So Much Talk and So Little Action?, Three “Inconvenient Truths” about Health Care, The Perfect Storm of Overutilization, Who Really Pays for Health Care? The Myth of Shared Responsibility, What Are The…

USA - On the Rise of Health Spending and Longevity

The authors use a calibrated stochastic life-cycle model of endogenous health spending, asset accumulation and retirement to investigate the causes behind the increase in health spending and life expectancy over the period 1965-2005. They estimate that technological change along with the increase in the generosity of health insurance may explain independently 53% of the rise in health spending (insurance 29% and technology 24%) while income less than 10%.

USA - Aligning Forces for Quality Report. Local Efforts to Transform American Health Care

This special report from the Robert Wood Johnson Foundation’s (RWJF) Aligning Forces for Quality (AF4Q) initiative chronicles the program’s ambitious progress. AF4Q is the Foundation’s signature effort to improve the overall quality of health care in targeted communities, reduce racial and ethnic disparities and provide models for national reform. It asks the people who get care, give care and pay for care to work together toward common, fundamental objectives to lead to better care. The program works to improve health care in 15 communities, that together cover 11 percent of the U.S. population. It is the largest effort of its kind ever undertaken by a U.S. philanthropy.

USA - Enhanced Primary Care Case Management Programs in Medicaid: Issues and Options for States

Enhanced Primary Care Case Management Programs in Medicaid: Issues and Options for States, a resource paper published by the Center for Health Care Strategies (CHCS), examines enhanced PCCM programs in five states — Oklahoma, North Carolina, Pennsylvania, Indiana, and Arkansas. The paper describes several options for enhancing PCCM programs with a focus on strategies that can improve care management for beneficiaries with chronic illnesses and disabilities.

USA – Implementing State Health Reform: Lessons for Policymakers

Ce rapport détermine les principales questions auxquelles les concepteurs de politiques doivent réfléchir lors de l’implantation des réformes dans le secteur de la santé et fournit une série d’idées, particulièrement sur ce qui doit arriver sur le plan opérationnel avant et après l’implantation.

USA - Vermont's New Universal Health Care Law: a Model for Health Reform Based on Human Rights

A pioneering grassroots campaign for the right to health care has made Vermont the first state mandated by law to establish a universal, equitable health care system based on human rights principles.

USA - Maine launches new site to explain federal health care reform benefits

Maine residents will now be able to go online to learn about the benefits of federal health care reform. The state has recently launched a new Website which offers a full outline of the Affordable Care Act as well as Maine’s plan for implementation. The site will provide updated information about the state’s efforts with health care reform as well as meeting information from the Joint Select Committee on Health Care Reform and Implementation and federal resources.

USA - Hospital Performance, the Local Economy, and the Local Workforce: Findings from a US National Longitudinal Study

Pay-for-performance is an increasingly popular approach to improving health care quality, and the US government will soon implement pay-for-performance in hospitals nationwide. Yet hospital capacity to perform (and improve performance) likely depends on local resources. The authors of this study quantify the association between hospital performance and local economic and human resources, and describe possible implications of pay-for-performance for socioeconomic equity.

USA - A Path to Eliminating $3.6 Trillion in Wasteful Healthcare Spending

The result presented in this paper by Thomson Reuters is a vision of one path for reducing wasteful spending in healthcare over the next five to ten years. It tries to provide a balanced and specifically apolitical viewpoint equally weighing the concerns of patients, providers, payers, and purchasers. The document proposes five successful strategies to mitigate the six categories of waste identified in a previous white paper.

USA - New Health Reform Resource Center from the Commonwealth Fund

To mark the six-month anniversary of the passage of health reform, The Commonwealth Fund launched recently a new Health Reform Resource Center, the most comprehensive tool for exploring and understanding the provisions of the Affordable Care Act.

USA - Secretary Sebelius announces $130 million in grants to strengthen and expand the health professions workforce

HHS Secretary, Kathleen Sebelius,recently announced $130.8 million in grants to strengthen and expand the health professions workforce. Six areas are targeted: primary care workforce training, oral health workforce training, equipment to enhance training across the health professions, loan repayments for health professionals, health careers opportunity programs for disadvantaged students, and Patient Navigator outreach and chronic disease prevention in health disparity populations. The grants include $88.7 million in funding from the American Recovery and Reinvestment Act.

USA - The Impact of Health Reform on Health System Spending

This updated analysis, coauthored by Harvard University's David Cutler and The Commonwealth Fund's Karen Davis and Kristof Stremikis, projects the effect of national reform on total national health expenditures and the insurance premiums that American families would likely pay.

USA - The Vermont Accountable Care Organisation Pilot: A Community Health System to Control Total Medical Costs and Improve Population Health

For the last two years, Vermont’s Health Care Reform Commission has been exploring how the accountable care organisation (ACO) model might be incorporated into the state’s comprehensive health reform program. Three Vermont provider organisations are now in various stages of planning an ACO as part of a national learning network. This report identifies four levels of geographic scale that support an ACO and five functional capabilities needed for its success.

USA - Financial Incentives for Health Care Providers and Consumers

Health reform will emphasize financial incentives for providers and consumers to promote the use of effective health services and discourage the use of marginally effective or inappropriate services. This brief looks at evidence on the impact of financial incentives and draws lessons for policymakers.

USA - State Policymakers’ Priorities for Successful Implementation of Health Reform

This State Health Policy Briefing identifies and describes ten aspects of federal health reform that states must get right if they are to be successful in implementation. States that pursue the ten critical elements identified in this brief will have the greatest chance of achieving the goals embodied in the federal health reform law.

USA - U.S. Still Not Getting Good Value for Its Health Care Dollars

Despite having the most expensive health care system, the United States ranks last overall compared to six other countries—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—on measures of health system performance, according to a new Commonwealth Fund report.

USA - $250 Million Investment to Strengthen Primary Health Care Workforce

The U.S. Department of Health and Human Services Secretary Kathleen Sebelius recently announced a series of new $250 million investments to increase the number of health care providers and strengthen the primary care workforce. The new investments were made possible by the Affordable Care Act.

USA - The California HealthCare Foundation Launches the Health Reform and Public Programs Initiative

The new Health Reform and Public Programs Initiative will bring together grant dollars, internal expertise, and partnerships with other philanthropies, the government, and the private sector to support implementation of the health reform in California. The aim is to support the implementation of national health reform in California and advance the effectiveness of public coverage programs.

USA - New Toolkit - Fresh Ideas for Reporting on Health Reform

Now that health reform is law, reporters covering this subject have a new challenge: keeping readers, viewers and listeners engaged through the long implementation process. This new toolkit from the Alliance for Health Reform will help. It features story ideas from seasoned reporters and links to dozens of resources. It also included: list of experts with contact information and helpful websites.

USA — Partnership for Patients: Better Care, Lower Costs

The Obama Administration has launched the Partnership for Patients, a new public-private partnership that will help improve the quality, safety, and affordability of health care for all Americans. Using as much as $1 billion in new funding provided by the Affordable Care Act and leveraging a number of ongoing programs, the Department of Health and Human Services (HHS) will work with a wide variety of public and private partners to achieve the two core goals of this partnership – keeping patients from getting injured or sicker in the health care system and helping patients heal without complication by improving transitions from acute-care hospitals to other care settings.

USA - Obama administration issues new rules to cut red tape for doctors and hospitals, saving up to $9 billion

In August 2012, U.S. Health and Human Services (HHS) announced rules that cut red tape for doctors and hospitals and will save up to $9 billion over 10 years. The new rules streamline procedures for making healthcare claim payments and adjustments electronically. Time and costs for physician practices and hospital administrations will be reduced substantially.

USA – Implementation of Lean in a Community Health Center : A Case Study

Published by the American Institutes for Research in July 2012, this paper examines “Lean,” an organizational redesign approach that focuses on eliminating waste, defined as any activity that consumes resources without adding value for clients. The case study looks at the implementation of Lean at a non-profit community healthcare organization with 160,000 patients in California.

USA - New Study: U.S. Performs Worst On Potentially Preventable Death Rates Compared To France, Germany, and The U.K.

On August 29, 2012, The Commonwealth Fund released a study showing that the U.S. lags three other industrialized nations — France, Germany, and the U.K. — in its potentially preventable death rate, and in the pace of improvement in preventing deaths that could have been avoided with timely and effective health care.

USA - Wait Time for Treatment in Hospital Emergency Departments: 2009

This Data Brief from the U.S. Department of Health and Human Services reveals that from 2003 through 2009, the mean wait time in U.S. emergency departments (EDs) increased 25%, from 46.5 minutes to 58.1 minutes.

USA - Financial incentives can undermine motivation and worsen performance

This editorial published in the British Medical Journal warns that pay for performance schemes for health professionals undermine motivation, worsen performance and lead to systemic gaming. The editorial, supported by an analysis of financial incentives by Australia’s Bond University, concludes that many such schemes are based on questionable assumptions.

USA - National Health Expenditure Projections

This study, published in Health Affairs, projects modest annual growth of 4% in health spending in the US for 2011-13. Consumer use of health services is slow and is expected to remain so until coverage expands under the Affordable Care Act. The authors expect growth in health spending to reach 7.4% as the expansion begins in 2014.

USA - U.S. Health-Care System Faces Obstacles to Improving Health Care Value

The Boston Consulting Group assessed international progress in adopting value-based health care, and found the US trailing other countries. The assessment evaluates national health systems according to support at a national level for things like common national standards and IT infrastructure and the engagement of clinicians and policymakers. It also considers the quality of a country’s disease registries.

USA - Priority-Setting in Health: Building Institutions for Smarter Public Spending

This final report of the Priority-Setting Institutions for Global Health Working Group suggests that large efficiency gains could be achieved by introducing rules, processes and agencies with the sole function of speaking to priorities in health care. They would evaluate the relative costs and effects of different interventions, assess their affordability, deliberate on their distributional and ethical implications, and connect these recommendations to decisions on the use of public monies in the health sector.

USA - Shared-Savings Payment Arrangements in Health Care. Six Case Studies

American shared-savings programs are an alternative approach to paying health care providers. Providers receive a share of savings achieved by reducing costs for care. This Commonwealth Fund paper presents six case studies of pilot shared-savings programs.

USA - Bundled Payment: Effects on Health Care Spending and Quality: Evidence Report

This evidence report from the Agency for Healthcare Research and Quality (AHRQ) evaluates the effects of bundled payment systems on health care and quality of care. The report is part of Closing the Quality Gap, a series updating a 2004 collection of quality improvement strategies.

USA - A Guide to Physician Integration Models for Sustainable Success

As healthcare delivery and financing shifts from a volume-based to value-based business model, improved alignment between hospitals and physicians will be essential. This guide published by the Health Research & Educational Trust describes requirements for successful hospital-physician integration, and offers an overview of models currently being used in US health systems.

USA - Extended Office Hours and Health Care Expenditures: A National Study

A key component of primary care improvement is timely access to care. However, little is known about the effects of extended office hours on access. This study from Annals of Family Medicine examines the association between reported access to extended office hours and health care expenditures and mortality.

USA - Controlling Health Care Costs in Massachusetts with a Global Spending Target

In 2012, Massachusetts enacted legislation to control state health costs and improve standards. The new act created an annual spending target for total health care expenditures that was tied to economic growth. This article from the Journal of the American Medical Association (JAMA) explores the Massachusetts legislation.

USA - Best Care at Lower Cost: The Path to Continuously Learning Health Care in America

Published by the Institute of Medicine (IOM), this report from the Committee on the Learning Health Care System explores the economic challenges of US healthcare today. The report analyzes imperatives for change and discusses the financial, administrative and technological solutions that will make needed transitions successful.

USA - Health Care Law Saved An Estimated $2.1 Billion For Consumers

According to a September 2012 report by the US Department of Health and Human Services, healthcare legislation in the 2011 Affordable Care Act has saved American consumers an estimated $2.1 billion on health insurance premiums. New rate review rules prevent insurance companies from arbitrarily raising rates.

USA - Adapting Tools from Other Nations to Slow U.S. Prescription Drug Spending

Other countries pay lower prices for brand-name drugs than the U.S. This paper from Policy Analysis looks at methods used by other national health systems that could achieve drug savings in the U.S. The authors focus mainly on British comparative-effectiveness research and Australia’s reference pricing.

USA - A CEO Checklist for High-Value Health Care

This discussion paper reflects an Institute of Medicine Roundtable Discussion among the CEOs of major American health systems. It provides a checklist of 10 strategies that, in their experience, have proven effective and essential to improving quality and reducing costs.

USA - Competitive bidding saving money for taxpayers and people with Medicare

People with Medicare are already saving money on durable medical equipment through the Medicare competitive bidding program, according to a report released by the US Department of Health and Human Services. The current process is benefiting older people and people with disabilities now, but benefits will expand as the Affordable Care Act broadens application of cost reduction opportunities to other areas.

USA - The Performance Improvement Imperative. Utilizing a Coordinated, Community-Based Approach to Enhance Care and Lower Costs for Chronically Ill Patients

In this paper, the Commonwealth Fund Commission on a High Performance Health System proposes the US create 50 to 100 voluntary “Health Improvement Communities” focused on patients with multiple, high-cost chronic conditions. Through payment reform, enhanced primary care, and health information technology, it maintains that this effort could yield $184 billion in savings.

USA - Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality

This analysis uses data from the Organization for Economic Cooperation and Development and other sources to compare health care spending, supply, utilization, prices, and quality in 13 industrialized countries: Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The U.S. spends far more on health care than any other country.

USA - Primary Care and Public Health: Exploring Integration to Improve Population Health

This book from the Institute of Medicine (IOM) identifies the best US examples of effective public health and primary care integration. It discusses how primary care systems and public health departments can integrate and coordinate disease prevention efforts.

USA - No Improvement in Patient Outcomes Seen in Hospitals with Pay-for-Performance Programs

This study from Harvard School of Public Health finds no evidence that America’s largest hospital-based pay-for-performance (P4P) program improved 30-day mortality rates, a measure of whether patients survive their hospitalization. The US currently plans to expand P4P to most hospitals by 2013.

USA - New health care law provisions cut red tape, save up to $4.6 billion

On April 9, 2012 the US Department of Health & Human Services (HHS) announced changes to the Affordable Care Act that will save health care providers and health plans $4.6 billion over the next decade by simplifying administrative processes for doctors, hospitals and insurance plans.

USA - For the Public's Health: Investing in a Healthier Future

This book by the Institute of Medicine (IOM) assesses financial challenges facing the US public health infrastructure. The book provides recommendations for sustainable funding and optimal infrastructure use by public health agencies.

USA - HHS launches new web-based tool to track performance of nation’s health care system

On May 15, 2012, the US Health and Human Services Secretary announced the launch of a new web-based tool, known as the Health System Measurement Project. It will allow policymakers, providers, and the public to develop consistent data-driven views of changes in critical US health system indicators.

USA - Massachusetts Lawmakers Unveil Ambitious Plan to Cut Health Care Costs

In May 2012, Massachusetts state lawmakers announced legislation to control rising medical costs. The proposals include new ways to pay doctors and institutions, a cap on healthcare spending tethered to economic growth, and a tax on expensive hospitals that cannot justify their prices.

USA - Alternatives to Fee-for-Service Payments in Health Care. Moving from Volume to Value

This report from the Center for American Progress examines the fee-for-service payment model and explores alternatives, including bundled payments, patient-centred medical homes, and accountable care organizations. The report compiles recent data from organizations that have tested each approach.

USA - Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System

This report by the Commonwealth Fund advocates tying future increases in US health spending to long-term GDP growth, while simultaneously moving to a high performance healthcare system. The report lays out a three-pronged strategy relying on provider payment reform, policies to encourage high-value choices by consumers, and system-wide action to improve healthcare markets.

USA - U.S. Health in International Perspective: Shorter Lives, Poorer Health

Published by the National Academies Press, this book examines the experience of health in the US, a wealthy nation whose population live shorter lives and experience more injuries and illnesses than people in all other high-income countries. The book results from a panel convened by the Institutes of Medicine (IOM) to investigate issues surrounding the “American health disadvantage.”

USA - HHS Health IT Safety Plan open for public comment

In December 2012, the US Department of Health and Human Services (HHS) released the Health IT Patient Safety Action and Surveillance Plan, a report on the ways health information technology can eliminate medical errors, improve quality of care, and make health care more efficient. The plan builds on a 2011 report from the Institute of Medicine (IOM).

USA - Reducing Waste in Health Care

A key target in slowing healthcare spending in the US is the elimination of waste, which is thought to constitute over one third of all American health spending. This policy brief published in Health Affairs focuses on the types of waste in health care and ways to eliminate it.

USA - Shared Decision Making Between Patients and Doctors Will Require Investment by Health Systems

Efforts to increase patient involvement in medical care face barriers such as overworked physicians and deficient medical information systems, according to a new RAND Corporation study. To make shared decision-making a reality, RAND researchers say doctors and other health workers need more instruction from providers and better information systems to make sure patients know their options.

USA - Health Care Costs: Solutions from HCFO Research

A research program of the Robert Wood Johnson Foundation (RWJF), Health Care Financing and Organization (HCFO) examines the cost impacts of existing healthcare policies, devises strategies to reduce costs, and formulates potential future costing approaches. The 24 previously published studies contained in this new HCFO research report deal with a variety of issues within these three categories.

USA - Why the Geographic Variation in Health Care Spending Can't Tell Us Much about the Efficiency or Quality of our Health Care System

This study from the Federal Reserve Board examines geographic variation in Medicare and non-Medicare health spending in the US. It finds the variation to be more attributable to socioeconomic factors than differences in practice style. The study goes on to show that geographic variation in health spending does not provide a useful inefficiency measure because of the difficulty in isolating effects.

USA - NGA Launches Virtual Health Resource Center

The National Governors Association (NGA) unveiled a resource website that explores solutions to health policy problems at the state level in the U.S. The site, State Health Policy Options, provides policymakers with expert analysis and data from other states on health care access, affordability and quality.

USA - Aligning Health Information Technology and Delivery System Transformation Efforts: Themes from a Discussion among State and National Leaders

This State Health Policy Briefing describes an April 2012 meeting between US state and national leaders to consider ways in which delivery system transformations can capitalize on information technology and improve health care. Provider and plan measurement, payment reform, care delivery innovation, and consumer engagement are discussed.

USA – Health Care Payment Reform Could Save U.S. $200 Billion-$600 Billion over Coming Decade, but Implementation Challenges are Substantial

According to this report by the Center for Health Reform & Modernization, the US could save $600 billion over the coming decade by reforming healthcare provider payment incentives, including the fee-for-service model. The report notes that physicians say care costs can be cut 18% without impacting quality.

USA - Obama administration moves forward to implement health care law, ban discrimination against people with pre-existing conditions

In November 2012, the re-elected Obama administration began implementing provisions in US health care law making it illegal for insurance companies to discriminate against people with pre-existing conditions. Other provisions of the 2010 Affordable Care Act will support employee wellness programs and make it easier for consumers to compare health plans.

USA - Design and Use of Performance Measures to Decrease Low-Value Services and Achieve Cost-Conscious Care

This article, published in the Annals of Internal Medicine, gives an overview of performance measures that target low-value services in order to help physicians understand the strengths and limitations of these measures. It also provides specific examples of measures that assess use of low-value services, and discusses how these measures can be used in clinical practice and policy.

USA - Less-Experienced Physicians Spend More Money Caring for Patients Than More-Experienced Physicians

According to this Rand Corporation study, physicians with less experience spend significantly more money treating patients than more experienced physicians. Published in Health Affairs, the study examines the link between physician characteristics and medical costs. Experts say less-experienced physicians could now be excluded from contracting networks or face lower pay.

USA - Curbing Costs Improving Care. The Path to an Affordable Health Care Future

Over the past year, the U.S. National Coalition on Health Care (NCHC) conducted an intensive dialogue with health care experts and organizations that represent businesses, consumers, health plans, providers, and disability advocates. This report is the product of those discussions. It offers federal policymakers a path forward to address the unnecessary growth in health care costs and to improve quality of care by transforming incentives for all actors in the health system.

USA - Thomson Reuters Announces Top Health Systems

Thomson Reuters released its fourth annual study identifying the top U.S. health systems based on balanced system-wide clinical performance. The study examined data from more than 300 American organizations and singled out 15 hospital systems that achieved superior clinical outcomes based on measures of quality, patient perception of care and efficiency.

USA - Slow Growth in Health Spending And Utilization Continues

Slowing growth in the use of health care goods and services caused a second slow year of health spending growth in the U.S., analysts report in Health Affairs. High unemployment, lower household incomes, and the loss of health insurance have forced many Americans to forgo care or find inexpensive treatments.

USA - The reform of American health care system

This synthesis, published in Pratiques et Organisation des Soins, explains the current American system, presents the reforms proposed by President Obama, the changes to the law introduced by Republicans, and the current status of the reform project.

USA - The U.S. health care system achieves a score of 64 out of 100 in the third National Scorecard on U.S. Health System Performance

The new U.S. National Scorecard updates assessments of population health and health care quality and access. Across 42 performance indicators, the U.S. achieved a score of 64 out of a possible 100 when comparing national rates with international benchmarks. The Scorecard concludes that the American health system continues to fall short, especially considering how much the country spends on health.

USA - Health reform law saves $2.1 billion for 3.6 million Americans with Medicare

This report from the U.S. Department of Health and Human Services (DHHS) shows that the nearly 3.6 million Americans enrolled with Medicare in 2011 saved $2.1 billion on prescription drugs because of legislation in the new Affordable Care Act. The Affordable Care Act provides a 50% discount on brand-name prescriptions along with a 14% discount on generic drugs through 2012-2013.

USA - Primary Care 2025: A Scenario Exploration

The Institute for Alternative Futures (IAF) provides, in this report, scenarios describing alternative futures for U.S. primary care in the year 2025. The scenarios consider economic challenges, political polarization, disruptive technological advances, and new health delivery systems. The report includes implications and recommendations for policy-makers envisioning the alternative paths 21st century primary care could take.

USA - Healthy People 2010 Final Review

On October 6, 2011, the U.S. Department of Health and Human Services (HHS) released a progress assessment of the nation’s health goals over the last decade. The report determined that Americans had met — or were moving toward meeting — 71 percent of the program’s 2010 targets, including those associated with reducing deaths from coronary heart disease and stroke.

USA - HHS launches new Affordable Care Act initiative to strengthen primary care

This September 28, 2011, news release from the U.S. Department of Health and Human Services (HHS) announces the launch of a new Affordable Care Act initiative to help primary care practices deliver coordinated and high quality patient-centered care. Under the new initiative, Medicare will work with commercial and state health insurance plans to support primary care doctors who better coordinate care.

USA – The State of Quality Improvement Science in Health. What Do We Know About How to Provide Better Care?

Quality improvement (QI) is considered a promising tool for transforming the health system. This paper looks at the evidence that supports QI’s ability to produce the intended effects. It looks at four fundamental questions about QI in health care, including how it has evolved over time, current evidence about its strengths and limits, what still needs to be learned, and what stakeholders can do to build capacity for QI research and practice.

USA - Hospitals and Care Systems of the Future

U.S. industry experts have projected that multiple pressures will drive the transformation of health care delivery and financing from volume- to value-based payments over the next decade. This inaugural report of the American Hospital Association (AHA) Performance Improvement Committee is based on interviews with policymaker to identify the strategies and competencies organizations should establish.

USA - An intervention to improve care and reduce costs for high-risk patients with frequent hospital admissions: a pilot study

In the U.S., a small percentage of high-risk patients account for a large proportion of Medicaid spending. This study by BMC Health Services Research reports on a new cost-effective pilot project study of an intervention to support high-risk patients requiring frequent hospital admissions.

USA - Essential Health Benefits: Balancing Coverage and Cost

This report from the U.S. Institute of Medicine (IOM) describes the criteria used to determine the essential health benefits (EHBs) most important for coverage under the 2010 Affordable Health Care Act. The IOM saw as its primary task to cover a broad range of services at a cost individuals could afford. An estimated 68 million Americans will now access care covered by EHBs.

USA - A new poll finds that a majority of Americans favor more government health services

A November 2011 poll by the Robert Wood Johnson Foundation (RWJF) and Harvard School of Public Health has found that 52% of Americans prefer a bigger government providing more health services. Just 37% supported a smaller government providing fewer health services. This contrasts other recent polls suggesting that Americans prefer a smaller government overall.

USA - Health Worker Shortages and Global Justice

According to the WHO, there is currently a serious global shortage of health workers in essential services. Published by the Milbank Memorial Fund, this report examines the crisis and its effects on the millions of people in the world who are losing access to care.

USA - Obama Administration takes new steps to encourage doctors and hospitals to use health information technology to lower costs, improve quality, create jobs

On November 30, 2011, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius released a report showing that doctors’ adoption of health information technology (IT) doubled in two years. As well, a Centers for Disease Control and Prevention survey found that 52% of office-based physicians in the U.S. now intend to take advantage of the incentive payments available to doctors and hospitals through the Medicare and Medicaid electronic health record (EHR) incentive programs. In addition to improving the health care system, data indicate that the national transition to health IT is creating jobs. Over 50,000 health IT-related jobs have been created since the enactment of the HITECH Act.

USA - To Reform Medicare, Reform Incentives and Organization

Authored by Professor Alain Enthoven, a pioneer of the concept of managed competition, this policy brief published by the Committee for Economic Development shows how to apply managed competition to Medicare in the U.S. The paper explains how the principles of cost-responsible consumer choice among competing health insurance plans can improve quality and reduce Medicare costs.

USA – Higher Fees Paid to U.S. Physicians Drive Higher Spending for Physician Services Compared to Other Countries

Physician spending per capita in the U.S. is higher than in other countries. Analysts agree that higher fees for physicians increase spending for their services. This study published in Health Affairs compares American prices for physician services with prices in Australia, Canada, France, Germany and the U.K. The study finds that U.S. public and private payers pay higher fees to primary care physicians.

USA - Major progress in doctors, hospital use of health information technology

On February 17, 2012, the U.S. Department of Health & Human Services confirmed that the number of American hospitals using health information technology (IT) more than doubled between 2010 and 2012, from 16% to 35%. Healthcare providers who use electronic health records (EHRs) to improve patient care are currently receiving incentive payments.

USA - Rising to the Challenge. Results from a Scorecard on Local Health Performance, 2012

In this Scorecard on Local Health System Performance, the Commonwealth Fund provides comparative data to help communities assess the performance of local healthcare systems. Comparing all 306 designated local health care areas in the U.S., the Scorecard finds that access, costs, quality and health outcomes vary significantly between communities, often with large variations in key indicators. Top-performing areas are concentrated in the American Midwest and Northeast.

USA - Public Reporting on Quality and Costs. Do report cards and other measures of providers’ performance lead to improved care and better choices by consumers?

This paper asks if public reporting of health provider performance leads to better consumer choices and improvements in care. Published in Health Affairs, the paper describes the theory behind public reporting, its evolution over time, and evidence as to whether it improves healthcare quality and lowers costs.

USA - Aspirin, Angioplasty, and Proton Beam Therapy: The Economics Of Smarter Health Care Spending

This paper from researchers at the Harvard School of Public Health was presented at the Jackson Hole Economic Policy Symposium in September 2011. The paper looks at inefficiencies and unsustainable spending levels within the U.S. healthcare system. It contrasts the under-use of cost-effective treatments like aspirin and immunizations with the use of treatments that are inappropriate, such as angioplasty, or non evidence-based, such as proton beam therapy.

USA - Study Finds Consumers Choose High-Value Health Care Providers When Given Good Cost and Quality Information

According to this study from the Agency for Healthcare Research and Quality (AHRQ), U.S. consumers consistently associate more expensive healthcare options with higher quality care. However, when shown detailed cost and quality information, consumers instead choose providers who deliver high-quality care at a lower cost. The study's findings have many implications for the design of provider report cards for the public.

USA - The Centers for Medicare & Medicaid Services (CMS) announces new initiative to bolster primary care workforce

The Centers for Medicare & Medicaid Services (CMS) has issued a call for applications for a new initiative to strengthen U.S. primary care. The CMS will provide hospitals and nursing schools that train Advanced-Practice Registered Nurses (APRNs) with up to $200 million over four years. APRNs are nurse practitioners who play a pivotal role in primary care.

USA - Paying More for Primary Care: Can It Help Bend the Medicare Cost Curve?

In 2011, the U.S. health reform law boosted Medicare fees for primary care visits by 10% for five years. This study by the Commonwealth Fund evaluates the impact of making the fee increase permanent, showing that it would yield a six-fold annual return in lower Medicare costs for other services, mostly inpatient and post-acute care. The net result would be a drop in Medicare costs of nearly two percent.

USA - Primary Care: Today and Tomorrow

This issue brief from consultancy Deloitte was prepared to anticipate new need for primary care generated by the increase in insured patients that will come with implementation of the Affordable Care Act in the U.S. It considers new models and tools for primary care as well as new incentives, such as pay for performance and value-based design, medical homes, and Accountable Care Organizations (ACOs). It also discusses some of the barriers to implementing new models.

USA - Physician-Leaders and Hospital Performance: Is There an Association?

This discussion paper from the Institute for the Study of Labour (IZA) in Germany seeks to fill the evidence gap around the assumption that physicians make better hospital leaders than non-physicians. The authors looked at quality data from the top 100 U.S. hospitals and researched the personal histories of the 300 CEOs of these hospitals to classify them into physician and non-physician managers. They found a strong positive association between the ranked quality of a hospital and whether the CEO is a physician.

USA - Public Health Accreditation Board (PHAB) Launches National Accreditation for Health Departments

The goal of PHAB’s accreditation program, initiated and supported by the Robert Wood Johnson Foundation (RWJF) and the Centers for Disease Control and Prevention (CDC), is to protect and improve Americans’ health by advancing the quality and performance of all of the nation’s public health departments — state, local, territorial and tribal. It aims to create a national standard for public health. Accreditation is seen as a powerful way to publicly recognize that health departments are doing a good job, while at the same time driving them to continuously improve.

USA - Vice President Biden announces over $2 billion in anti-waste measures at Cabinet meeting

Joined by Health and Human Services (HHS) Secretary Kathleen Sebelius, the American vice president discussed a new initiative to fight waste and fraud in Medicaid. The new program is based on the successful Medicare Recovery Audit Contractor program, which the vice president announced has already recovered nearly $670 million to date in 2011.

USA - Shortchanging America's Health. A State-by-State Look at How Public Health Dollars Are Spent

A March 2010 report from the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) found federal spending for public health has been flat for nearly five years, while states around the country cut nearly $392 million for public health programs in the past year. These cuts leave communities around the country struggling to deliver basic disease prevention and emergency health preparedness services.

USA - Intentional whole health system redesign: Southcentral Foundation’s ‘Nuka’ system of care

This article looks at Alaska’s Southcentral Foundation, regarded as one of the world’s most successful examples of health system redesign. State-funded, run by Alaskan Natives, and responsible for the health care of Alaska’s indigenous peoples, Southcentral drastically improved its health services and outcomes by integrating service delivery and instituting a culturally-responsive system of care. The article considers lessons learned and analyzes key messages.

Australia - How! Not How Much: Medicare Spending and Health Resource Allocation in Australia

This monograph argues that four key principles should guide the debate about structural health reform: 1. Scarce health resources and subsidised access to health services must be allocated on a needs basis to ensure timely access to essential hospital care. 2. Excessive, universal subsidisation of minor health expenses must cease. 3. Medicare must be de-monopolised and replaced with a soundly constructed competitive insurance system that properly protects people against the risk and high cost of exceptional health events. 4. To promote personal responsibility for health costs, and control usage of health services while avoiding arbitrary rationing, a rational system of insurance deductibles and copayments must apply for non-chronic care and marginal hospital procedures, which can be paid for out of personal ‘health savings’.

Brazil - Considerations on the Brazilian national health system (SUS) performance index

One of the quality measures used by Brazil’s National Health System (SUS) is the Brazilian National Health System Performance Index (IDSUS), which assesses the effectiveness of health care in municipalities and regions. This study looks at the potential of IDSUS to improve Brazilian public health management, but finds that its application and usage remains patchy across the country.

USA - A systematic review of team-building interventions in non-acute healthcare settings

Healthcare is increasingly delivered in a team-based format emphasizing interdisciplinary coordination. Analyzing the evidence base for team-building interventions in non-acute settings (primary care and rehabilitation clinics), this systematic review examined 14 team-building interventions and 25 manuscripts describing empirical studies of these interventions. A lack of control conditions, inconsistency in outcome measures, and high probability of bias tempered positive findings regarding the utility of team-building interventions.

Europe - Commission steps up efforts to increase availability and boost healthcare data sharing

On April 25, the European Commission proposed measures to assure better access to, and reusability of, public sector data. These accompany a General Data Protection Regulation that will come into effect on May 25, 2018. The new measures include the creation of a European Open Science Cloud to improve access to scientific information; fostering cooperation to make better use of health data, including genomic data; and improving the interoperability of electronic health records to enable data to be shared across borders. The proposal will now go to European Parliament.

UK - How good is the NHS?

Comparing the UK National Health Service (NHS) with its international peers, this report shows that treatment wait times are in line with similar countries and that the NHS is relatively efficient, with lower than average administrative costs and widespread usage of cheaper medicines. However, patient outcomes remain poorer than the international average, with higher mortality rates for cardiovascular disease, cancer and stroke.

Governance in the health sector: a strategy for measuring determinants and performance

Brief analytical summaries or syntheses #22 Governance in the health sector a strategy for measuring determinants and performance Summary Governance in the health sector a strategy for measuring determiMany different strategies have been proposed to improve the delivery of health care services, from capacity building to establishing new payment mechanisms. Recent attention has also looked at whether improvements in the way health care services are governed could make a difference. These approaches ask which factors, such as rules and institutions, influence the behaviour of the system, its performance and outcomes. The paper proposes specific measures of governance determinants and performance and describes the instruments available to collect and interpret them. Background While the term “governance” is increasingly being used to draw attention to a number of factors that affect the quality, effectiveness and reach of social services, no consensus has emerged on definitions, frameworks and, in particular, how it applies…

Re-orienting health systems : Towards modern, responsive and sustainable health promoting systems

Brief analytical summaries or syntheses #55 Re-orienting health systems Towards modern, responsive and sustainable health promoting systems Summary This position paper from EuroHealthNet is the culmination of a policy dialogue process with stakeholders, experts and European Union (EU) institutions to identify key contributions to sustainable health systems across Europe. The paper frames its findings in the context of the EU 2020 Europe strategy for continental growth. Background The sustainability of national health systems is a core concern of the European Member States, the European Commission, and the World Health Organisation. As early as 2001, the European Commission identified ‘financial viability’ as one of three long-term objectives for national health systems, along with accessibility and quality. Since then, the development of high-quality, accessible and sustainable services has been in the spotlight of different EU policy agendas social protection, public health, and economic and financial affairs. Initially, the issue was incorporated in…

International - A systematic approach to the planning, implementation, monitoring, and evaluation of integrated health services

Published by BMC Health Services Research, this study develops a systematic country-specific approach to the development of integrated health services. It applies principles from existing monitoring and evaluation frameworks to country-specific health challenges, which integration is meant to improve, and includes recommendations about improvements to health information systems and data usage.

USA - The use of medical technology in the United States increased dramatically between 1996 and 2006, according to "Health, United States, 2009"

Health, United States, 2009 is the federal government’s 33rd annual report to the President and Congress on the health of all Americans. The report was prepared by the Centers for Disease Control and Prevention’s National Center for Health Statistics from data gathered by state and federal health agencies and through ongoing national surveys. This year's edition features a special section on medical technology, and finds that the rate of magnetic resonance imaging, known as MRI, and computed and positron emission tomography or CT/PET scans, ordered or provided, tripled between 1996 and 2007.

UK — GP Commissioning in the NHS in England: Ten suggestions from the United States

Nuffield Trust Viewpoints provide a platform for UK and international health leaders to explore, debate and discuss critical health care reform issues. In the first of the series, a leading scholar from the US sets out what the NHS in England could learn from the US experience of doctor-led commissioning.

Finland - eHealth and eWelfare of Finland - Checkpoint 2011

This report was produced by the National Institute for Health and Welfare, Finland, and FinnTelemedicum, from the results of the national eHealth implementation survey. It describes the status and trends in health care information and communication technology and eHealth usage in Finland in 2011, comparing the results with earlier surveys carried out in 2003, 2005 and 2007.

USA - Tools for Supporting Social Service and Health Care Partnerships to Address Social Determinants of Health

The Center for Health Care Strategies (CHCS) has identified new strategies to facilitate partnerships between community-based organizations (CBOs) and healthcare institutions that effectively address social determinants of health. The CHCS provides a set of resources and tools to strengthen collaborative activities. They include partnership models, value articulation, and ways to accurately estimate the costs of partnering.

US - Centers for Medicare & Medicaid Services created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily

CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions. The Nursing Home Compare Web site now features a quality rating system that gives each nursing home a rating of between one and five stars.

US - Annual cost of medical liability in US is $56bn, study estimates

The costs associated with medical liability - including legal costs and payouts associated with medical malpractice cases, malpractice insurance, and the practice of defensive medicine—total $55.6bn a year or 2.4% of annual healthcare spending in the United States, concludes a study aimed at estimating the direct and indirect costs of protecting against medical negligence. The results showed that most of the cost, an estimated $45.6bn, was due to defensive medicine, including tests or treatments carried out largely to avoid potential lawsuits.

US - State Reform Dominates Boston Health Care Market Dynamics

In March 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study, visited the Boston metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 50 health care leaders, including repre¬sentatives of major hospital systems, physician groups, insurers, employers, benefits consultants, community health centers, state and local health agencies, and others. Researchers also conducted several follow-up interviews by phone from April through July 2010. This paper presents the conclusion of this study.

US - Regional and Racial Variation in Primary Care and the Quality of Care among Medicare Beneficiaries

This Dartmouth Atlas Project report updates and extends previous reports on geographic variation in health care quality and health outcomes, this time with a focus on access to and use of primary care.

UK - How hospital activity and funding in England have changed over time

The UK National Health Service (NHS) is currently struggling to maintain standards of care. Reviewing data from England since 2003, this article shows that rising demand has dramatically increased hospital activity (admissions, referrals, outpatient services, and diagnostic tests) during a period of unprecedented decreases in funding. Rising hospital usage is attributed to population growth and aging, and advances in medical treatment.

US - The Effect of Financial Incentives on Hospitals That Serve Poor Patients

Providing financial incentives to hospitals to improve quality is increasingly common, yet its effect on hospitals that care for poor patients is largely unknown. The aim of this study is to determine how financial incentives for quality performance affect hospitals with more poor patients compared with those with fewer poor patients.

US - Starting on the Path to a High Performance Health System: Analysis of the Payment and System Reform Provisions in the Patient Protection and Affordable Care Act of 2010

This report, originally published in December 2009 and since updated to reflect the March 2010 passage of the Patient Protection and Affordable Care Act, analyzes the provisions in the new law that will affect providers' financial incentives, the organization and delivery of health care services, investment in prevention and population health, and the capacity to achieve the best health care and health outcomes for all.

Europe - Europe paying a heavy price for chronic diseases, finds new OECD-EC report

Better public health and prevention policies as well as more effective health care could save hundreds of thousands of lives and billions of euros each year in Europe, according to a new joint OECD/European Commission report. Besides the loss of lives and the human tragedy that this always entails, Health at a Glance: Europe 2016 estimates that the premature deaths of 550,000 working age people across European Union countries from chronic diseases, including heart attacks, strokes, diabetes and cancer, cost EU economies EUR 115 billion or 0.8% of GDP annually.

Russian Federation – Health System Review.
Health systems in transition, 2011

Brief analytical summaries or syntheses #37 Russian Federation – Health System Review. Health systems in transition, 2011 Summary The WHO produces health system profiles (HiTs), which are country-based reports providing a detailed description of health systems and policy initiatives. This HiT on the delivery of health care in Russia examines different approaches to the organization, financing and delivery of health services in that country, along with the roles of main local actors. Background At independence from the Soviet Union in 1991, the Russian health system inherited an extensive, centralized Semashko system, but was quick to reform health financing by adopting a mandatory health insurance (MHI) model in 1993. While the health system has evolved and changed significantly since the early 1990s, the legacy of having been a highly centralized system focused on universal access to basic care remains. High energy prices on world markets have ensured greater macroeconomic stability, a…

Brazil - Is Universal Health Care in Brazil Really Universal?

Since Brazil’s adoption of a universal health care policy in 1988, the country’s health care has been delivered by a mix of private and free public providers. The authors of this paper examine whether income-based disparities in medical care usage still exist after the development of the public network using a nationally representative sample of over 44,000 Brazilians from 2003.

Canada - Changing Directions, Changing Lives: The first mental health strategy for Canada

This strategy is a culmination of the hard work and advocacy of thousands of people all across the country. It offers recommendations to improve mental health and well-being throughout Canada. It represents a blueprint for change and provides six strategic directions to improve mental health care in Canada.

Canada - New data shows continued improvements in Canada’s health system performance

Canada’s health system performance is showing continued improvements according to new data from the Canadian Institute for Health Information (CIHI). The CIHI reports improvements in long-term care (lower usage of restraints and inappropriate antipsychotics); hospital deaths (a 3% improvement in 2015-2016); and wait times in emergency departments (down slightly from 2013-2014).

International - Accountable care organisations (ACOs) in the United States and England: testing, evaluating and learning what works

In the US, accountable care organizations (ACOs) are health providers responsible for the comprehensive care of a given population over a specified period of time. This study describes different types of ACO and presents early evidence on their performance. The authors then discuss the implications of ACO development for integrated care initiatives in England.

UK - Patients are getting excellent or very good care in the NHS but more needs to be done

On February 14, 2012, Britain’s Department of Health released results of the 2011 Patient Experience Outpatient Survey. Seventy-two thousand outpatients across the National Health Service (NHS) were interviewed. Almost 84% rated their experience as very good. However, 65% were not told how long they would have to wait for an appointment, and did not know what to expect.

Canada - New report shows overuse of diagnostic imaging and inappropriate prescribing

A report released recently by the Health Council of Canada, Decisions, Decisions: Family Doctors as Gatekeepers to Prescription Drugs and Diagnostic Imaging in Canada , calls for better management of prescription drugs and diagnostic imaging services in this country. The report examines the increasingly complex role of family physicians and the effects of their decisions on usage of Canada’s health care services.

International - The Challenge of Financing Health Care in the Current Crisis: An Analysis based on the OECD Data

The ratio of health expenditure to GDP, which in macroeconomic terms is an indicator which summarises the financing needs of a national health system, is likely to rise in countries for which the GDP falls. Over the past four decades, in most countries health expenditure has risen at a faster rate than GDP, leading to a rise in the expenditure ratio. Fluctuations in this ratio can come about through fluctuations in either of its components. In some cases, notably in the USA, GDP variation is the main origin of changes in the ratio, but in the majority of countries health expenditure variation is more important. The experience of countries which did reduce health expenditure after previous recessions suggests that such reductions are short-lived, and demand for health services results over time in a revival of health expenditure growth.

How health systems make available information on service providers: experience in seven countries

Brief analytical summaries or syntheses #16 How health systems make available information on service providers experience in seven countries Summary This technical report examines seven countries' experience with systems that release information on the performance of healthcare providers. It is meant to guide the further development of quality information systems in Britain's NHS. Systems in Denmark, England, Germany, Italy, the Netherlands, Sweden and the United States are reviewed. Background There is growing interest in the public release of information on the performance of healthcare providers as a means to improve the quality of care and promote transparency and accountability. Countries have made considerable investments in creating systems to make available such information. However, there is lack of systematic comparative assessment of such systems. The report aims to help fill the gap by reviewing the information systems reporting on the quality of healthcare provision in seven countries. Analysis and results The…

Do quality improvements in primary care reduce secondary care costs ?

Brief analytical summaries or syntheses #15 Do quality improvements in primary care reduce secondary care costs ? Summary The introduction in 2004 of the Quality and Outcomes Framework (QOF) in general practice in the United Kingdom represents one of the most ambitious efforts to measure and incentivise quality improvements in primary care. The report takes advantage of a database of over 50 million English citizens to determine whether quality and outcomes efforts in general practice have led to improvements in two major outcomes mortality and the costs of hospital inpatient and outpatient use. The study finds that primary care performance improvements are associated with some modest but measurable improvements in outcomes and costs. Background The report seeks to determine whether the levels of QOF attainment in general practice have led to quality improvements in two major indicators mortality and the costs of hospital inpatient and outpatient care. The NHS faces…

USA - Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy

Gathering data from 30 physician practices in six US states, this RAND Corporation project analyzed factors influencing physician professional satisfaction. The study found that factors such as autonomy, collegiality and work quantity all strongly affected professional satisfaction, as did payment considerations, perceptions of care quality, and access to the use of electronic health records.

International - International profiles of health care systems

This publication from the Commonwealth Fund presents overviews of health care systems in nine European countries, Japan, Australia, Canada, and the U.S. Each overview covers insurance, financing, organization, quality of care, health disparities, efficiency and integration, information technology usage, use of evidence-based practice, cost containment, and reform and innovation. Summary tables provide data on key characteristics and performance indicators.

International – Development of predictive models in international health systems

Predictive models of health usage events, such as unplanned hospitalizations or entry into a care home, have been under development for a decade. A risk score is calculated for each individual, according to the probability that the event will occur. This article describes the different uses of this information for resource allocation, improvement of care pathways, remuneration and evaluations.

UK - Telehealth: what can the NHS learn from experience at the U.S. Veterans Health Administration?

Published on the website, this comparative study examines the largest implementation of telehealth anywhere, the Veterans Health Administration in the U.S. With the British government's announcement of the positive results of the Whole System Demonstrators and the launch of the 3 Million Lives Programme, this report is timely as U.K. stakeholders plan how to implement telehealth widely and deliver significant benefits.

UK - NHS England launches national programme to combat antibiotic overusage

The National Health Service (NHS) in England has launched an incentive scheme for hospitals and family doctors to prevent antibiotic resistance. Beginning in April 2016, the new program will offer millions of pounds of funding to English hospitals and general practices to support the reduction of inappropriate antibiotic prescribing.

Europe - eHealth in the EU: what's the diagnosis?

The European Commission undertook a broad survey of eHealth use in acute care hospitals and among GPs in member countries. Use is climbing but still only 60% of GPs were using eHealth tools in 2013. Denmark, Estonia, Sweden and Finland are top performers in hospital uptake, with rates over 60%. The Netherlands, Denmark and the UK have rates over 80% in digitising patient health records. However, many barriers remain to adopting eHealth, preventing more important usage. Only 10% of GPs use online consultations and only 9% of hospitals in Europe allow patients access to their own medical records.

Australia - Australian health expenditure by remoteness: a comparison of rural, regional and city health expenditure

The report looks at selected health services for the financial years 2001-02, 2004-05 and 2006-07 and examines the way these services were delivered across Australia. This analysis was performed using the Australian Standard Geographical Classification System to compare the expenditure and usage rates of the health services by residents of Major cities, Inner regional, Outer regional, Remote and Very remote areas of Australia.

Improving and measuring quality of care

Brief analytical summaries or syntheses #8 Improving and measuring quality of care Summary This publication presents new data on patient safety in OECD countries and shows that significant variations in quality of care persist in cancer, acute myocardial infarction and stroke, as well as in services provided by family physicians. The report looks at how countries can improve the measurement of quality, the balance between privacy and transparency in matters of quality and safety, and links between quality indicators and policies to improve the performance of physicians, hospitals and the health system as a whole. Background Health systems face important challenges today an increasingly complex case mix, greater demand for health care services (especially for chronic diseases) and an economic context in which improvements in care must come at the lowest possible cost. Measuring the quality of care becomes increasingly important in this context. Poor quality care undermines the goals…

US - How cultural alignment and the use of incentives can promote a culture of health

Drawing on interviews conducted with 43 healthcare stakeholders whose work focused on organizational culture and incentives, this report examines how organizations are addressing and leveraging these two topics to promote health, as well as to identify facilitators, barriers, best practices and lessons learned. The report is part of a series on building a culture of health in the US.

International - Which country has the world's best healthcare system?

Comparing health outcomes and value for money, this article from the UK’s Guardian newspaper examines health systems in France, Ireland, Sweden, China, USA, Japan, Spain, Italy, Germany, Russia, Australia and the UK. It finds that the UK has the best healthcare system overall, but notes that it also has the worst cancer outcomes of any rich country.

International - WHO updates Essential Medicines List with new advice on use of antibiotics, and adds medicines for hepatitis C, HIV, tuberculosis and cancer

The WHO has updated its Essential Medicines List to include a total of 433 medicines, adding 55 medicines and describing new uses for nine products. Along with new medicines for hepatitis C, HIV, TB and cancer, the list now groups antibiotics into three categories (Access, Watch and Reserve) with recommendations on usage.

USA - Home-Based Primary Care Interventions

Assessing evidence about home-based primary care (HBPC) interventions for adults with serious or disabling chronic conditions, this US comparative effectiveness review examines 19 studies published since 1998. While HBPC was seen to have a positive impact on patient and caregiver experience (including satisfaction, quality of life, and caregiver needs), the strength of evidence for these outcomes was low.

International — How health systems make available information on service providers: experience in seven countries

This report reviews information systems that report on the quality or performance of providers of healthcare in seven countries (Denmark, England, Germany, Italy, the Netherlands, Sweden and the United States) to inform the use and further development of quality information systems in the English NHS.