This report, sponsored by the American Medical Association (AMA), describes how alternative payment models (APMs) affect physicians, physicians’ practices, and hospital systems in the United States and also provides updated data to the original 2014 study. Payment models discussed are core payment (fee for service, capitation, episode-based and bundled), supplementary payment (shared savings, pay for performance, retainer-based), and combined payment (medical homes and accountable care organizations). The effects of changes since 2014 in the Affordable Care Act (ACA) and of new alternative payment models (APMs), such as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program (QPP), are also examined. This project uses the same qualitative multiple–case study method as the 2014 study, relying primarily on semistructured interviews with physician practice leaders, physicians, and other observers. Findings describe the challenges posed by APMs, strategies adopted to deal with APMs, the effects of rapidly changing and increasingly complex payment models, and how risk aversion influences physician practices’ decisions to engage in new payment models. Project findings are intended to help guide efforts by the AMA and other stakeholders to improve current and future APMs and help physician practices succeed in them. [Note: contains copyrighted material].
The Patient Protection and Affordable Care Act created a permanent risk adjustment program that aims to reduce incentives that insurers may have to avoid enrolling individuals at risk of high health care costs in the private health insurance market. Section 1343 of the ACA established the program, which is designed to assess charges to health plans that have relatively healthier enrollees compared with other health plans in a given state. The program uses collected charges to make payments to other plans in the same state that have relatively sicker enrollees. The Centers for Medicare & Medicaid Services (CMS) administers the risk adjustment program as a budget-neutral program, so that payments made are equal to the charges assessed in each state. CMS assesses payments and charges on an annual basis, beginning in the 2014 benefit year.
Supporters of Republican and Democratic candidates in the upcoming congressional election are deeply divided over the government’s role in ensuring health care, the fairness of the nation’s economic system and views of racial equality in the United States. [Note: contains copyrighted material].
In December 2017, the Urban Institute launched the Well-Being and Basic Needs Survey (WBNS) to monitor changes in individual and family health and well-being at a time when policymakers seek significant changes to programs that help low-income families pay for food, health care, housing, and other basic needs. The new annual survey is a key component of the Institute’s From Safety Net to Solid Ground project supported by the Robert Wood Johnson Foundation and other foundations.
This report describes the design and content of the WBNS. To assess the capacity of the WBNS to produce nationally representative estimates for the nonelderly adult population, we also report findings from a benchmarking analysis in which we compare estimates from the WBNS with estimates from established federal surveys. We find that, despite some discrepancies, most indicators based on data from the WBNS are reasonably consistent with measures from larger federal surveys, suggesting the WBNS data will serve as a credible source of information for analyses of health and well-being within the Safety Net to Solid Ground project. [Note: contains copyrighted material].
The Safe Drinking Water Act (SDWA) is the federal authority for regulating contaminants in public water supplies. The act includes the Drinking Water State Revolving Fund (DWSRF) program, established in 1996 to help public water systems finance infrastructure projects needed to comply with federal drinking water regulations and to meet the act’s health protection objectives. Under this program, states receive annual capitalization grants from the U.S. Environmental Protection Agency (EPA) to provide financial assistance (primarily subsidized loans) to public water systems for drinking water projects and other specified activities. Through FY2018, Congress has appropriated a total of $20.41 billion for the program. From FY1997 through FY2017, states provided $35.38 billion in DWSRF assistance to water systems for 14,090 projects.
The Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Services have implemented Million Hearts (MH), an unprecedented initiative to coordinate efforts across the United States to promote cardiovascular health. In work conducted by RAND Corporation and the University of Colorado at Denver, researchers sought to develop information and a data-informed evidence base regarding the successes and challenges of MH. To accomplish these aims, researchers used a mixed-methods approach that involved an environmental scan, key informant interviews, and a social network analysis to assess the current state of MH and to understand how this initiative might grow and strengthen the goal of decreasing cardiovascular disease (CVD). Based on their analysis, researchers conclude that the MH network has been successful in engaging a diverse set of public and private partners to collaborate together to address CVD issues and become an effective information-sharing network. Further, MH partners placed high levels of trust and value in one another. They also indicated that participation in the network was beneficial to their organizations. It appears that keeping the network intact, as is, can have some tangible benefits without a lot of additional resources or change. However, this research did identify barriers that participants in MH experienced in implementing MH activities or building effective relationships, including a lack of direct funding, difficulties with bringing partners to the table, a lack of experience among partners, and different perspectives on CVD prevention among partners. [Note: contains copyrighted material].
The Supplemental Nutrition Assistance Program (SNAP) provides benefits to low-income, eligible households on an electronic benefit transfer card; benefits can then be exchanged for foods at authorized retailers. SNAP reaches a large share of low-income households. In FY2017, a monthly average of 42.2 million persons in 20.9 million households participated in SNAP.