How well do ...

How Well Do Americans Understand Prevention Guidelines?

A Milbank Quarterly study finds that adults have low levels of knowledge about and trust for clinical service guidelines, such as cancer-screening tests.
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America’s ‘Lead Wars’

Flint, Michigan, isn’t the only place in America with a lead problem. David Rosner and Gerald Markowitz, authors of Lead Wars, a 2013 UC Press/Milbank Book, were interviewed on NPR’s Fresh Air.
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From The Milbank Quarterly

Our Op-Ed section features some of the best minds currently working to improve the public's health. 
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Our Mission

The Milbank Memorial Fund is an endowed operating foundation that works to improve the health of populations by connecting leaders and decision makers with the best available evidence and experience.
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A Blueprint for Repair and Renovation of the ACA The Importance of Physicians' Financial Disclosure for the Public's Health A Tale of Two Diseases: Mental Illness and HIV/AIDS Clash of the Titans: State All-Payer Claims Reporting Systems Meet ERISA Preemption Courting Disaster: Environmental Justice and the US Court System Accountability for Health Meeting the ACA's Goals

Milbank Quarterly Early View Op-Ed: John E. McDonough on Behind the Bipartisan Kumbaya on Opioids and Drug Abuse

April 26, 2016

For several years, Republicans and Democrats alike have been concerned about the crisis of opioid and heroin addiction in the United States. It is hard to find anyone who rejects the notion of a serious problem that demands at least a partial governmental response. Across the nation, governors and legislatures are hard at work seeking solutions and avoiding partisan bickering.  Numerous current and former presidential candidates in the 2016 campaign cycle got favorable attention explaining how the crisis has affected their families and friends in personal ways.

The question is whether there is any meaningful difference between Republicans and Democrats when it comes to substance abuse (and, for that matter, behavioral health—the merger of substance abuse and mental health)? In this Early View Op-Ed, John McDonough says that answer is yes and the difference comes down to the Affordable Care Act.

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UPDATE: Christopher F. Koller on a Big Week for Primary Care Transformation

April 15, 2016

This has been a big week for supporters of multi-payer alignment in health care and primary care transformation. On Monday, April 11, the Centers for Medicare and Medicaid Innovation (CMMI) announced that they will be implementing a new payment model—Comprehensive Primary Care Plus (CPC+). On Thursday, they released much delayed results from the evaluation of the second-year performance of the Comprehensive Primary Care (CPC) initiative payment model, the precursor to CPC+.

CPC+ represents a significant expansion to CMMI’s commitment to multi-payer primary care transformation. In fact, it also represents the country’s biggest commitment in health care to multi-payer financial alignment. With abundant evidence supporting the relationship between a high-performing primary delivery system and improved population health, the Fund has, through its Multi-State Collaborative, supported markets in CPC. So how is this payment model, with its two key components—primary care transformation and multi-payer alignment—doing?

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REPORT: Assessing the Effects of Primary Care Transformation: Emerging Themes and Practical Strategies to Strengthen the Evidence

March 30, 2016

The 18 projects involved in the Milbank Memorial Fund’s Multi-State Collaborative (MC) are engaged in multi-payer primary care transformation—and learning how to do it better. Assessing their own projects and acting on those findings have been important components of the MC programs. To help MC members learn how to do better evaluations and improve the effectiveness of their projects, the Fund engaged Mathematica Policy Research to develop this report and “evaluate the evaluations.”

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Massachusetts Moves Forward on Activities to Limit Health Care Cost Growth

March 23, 2016

How fast are health care costs growing in your state? What services or populations seem to be contributing most to those cost increases? Understanding the growth rate is important information for the financial health of states, as they struggle to provide needed services while limiting tax increases. The growth rate also has direct consequences for consumers, as health plan cost sharing has increased.

About a year ago, the Fund published a report that described and analyzed state models for health care cost measurement. Since that time, the states in the report—Maryland, Massachusetts, Oregon, and Vermont—have continued to analyze their health care costs and work on policies to limit cost growth. Already a model for much of the work of the Affordable Care Act, Massachusetts’ cost measurement activities may provide lessons for the rest of the country.

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View From Here

Christopher F. Koller
President of the
Milbank Memorial Fund

Payment Reform: Innovation, Evaluation, and Perspiration

My e-mail inbox is full of innovations—solicitations for health care meetings, most offering “unique opportunities” to hear from “national leaders,” all of whom are busy innovating.

Much of the conference fodder focuses on payment reform. Thanks largely to the Affordable Care Act (ACA), the federal government—of all places—is an agent of innovation, paying for new services in new ways through initiatives, programs, and payment mechanisms such as episodes of care, accountable care organizations, health homes, and comprehensive primary care. The commercial insurance industry is following suit, and we are awash in a veritable tsunami of innovations. Value-Based Payments and Alternative Payment Mechanisms—involving population-based payments, risk-sharing arrangements, bundled payments and pay for performance—are swamping the industry.

Innovation is not the same as improvement, however. Payment innovations may create employment opportunities for consultants, but do they work?

Effective Public Management of Mental Health Care:
Views from States on Medicaid Reforms That Enhance Service Integration and Accountability

Co-published with the Bazelon Center for Mental Health Law

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