In what can only be described as an adverse outcome for states seeking to better understand their health spending so as to improve care and lower costs, the U.S. Supreme Court issued a 6-2 decision that deals a serious blow to All-Payer Claims Databases (APCDs). APCDs, which are presently in use in at least 18 states, require payers to provide states with information on all health care claims. The decision means that self-insured plans – those governed by federal law under the Employee Retirement Income Security Act (ERISA) – cannot be compelled to share their data with states. This significantly compromises the accuracy of APCD data. In its decision, the court indicated that the U.S. Department of Labor may be able to compel collection of this data, which may provide states with an alternative avenue to obtaining the data.
Stricter CMS Star-Rating Bonus System for Medicare Advantage Plans Seems to be Leading to Quality Improvements
The Kaiser Family Foundation reports that the quality-related bonus payments that now apply to Medicare Advantage (MA) plans seem to be having a positive impact on patient care. Many MA plans have taken steps to improve their star quality ratings in order to obtain significant bonus payments from Medicare. Such improvements include increased screening for osteoporosis, insuring that larger numbers of patients have their high blood pressure under control and handling complaints and appeals in a more consumer-friendly way. While results are still early and more research is needed, this is an encouraging early finding for using financial incentives to improve care for vulnerable patients.
The Center for Consumer Engagement in Health Innovation (CCEHI) at Community Catalyst submitted several sets of formal comments in the last few weeks:
- CMS’ Draft Quality Measure Development Plan
- CMS’ 2017 Medicare Advantage Advance Notice and Call Letter
- Health Care Payment Learning & Action Network’s Accelerating and Aligning Population-Based Payment Models Draft White Papers on:
Looking Beyond 2016 Elections to Possible Areas for Bipartisan Discussion on Social Determinants of Health
In an article in the American Journal of Public Health, John McDonough discusses the need to increase spending on services that address the social and economic determinants of health in order to improve health outcomes in the U.S., and posits there may be potential openings for bipartisan efforts in this area. In a response, Brookings Institution Senior Fellow Stuart Butler largely agrees with McDonough, and takes the discussion a step further by outlining several areas that offer the possibility of future bipartisan consensus. The authors concur that such no such progress is likely to emerge during the fractious 2016 Presidential race, but Butler encourages beginning quieter conversations now about policy options that could better balance medical and social service spending in the hope some progress can occur “after the election dust has settled.”