August 2014 Newsletter
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New Report: Aligning Payers and Practices to Transform Primary Care

We are learning two things about restructuring health care in the United States in the post-Affordable Care Act (ACA) environment: Primary Care transformation is essential to a well-performing health care delivery system—and payment reform works best when it is consistent across payers.

These things are easier said than done, but the evidence and experience indicate they are possible. A new Milbank Memorial Fund report, “Aligning Payers and Practices to Transform Primary Care: A Report from the Multi-State Collaborative,” describes the efforts in states to take on these challenges.

The report details the experiences of the Multi-State Collaborative (MC), a voluntary group composed of representatives of state-based, multi-payer primary care transformation initiatives that are themselves collaborations between payers, providers, employers and state officials. With support from the Milbank Memorial Fund since 2009, the MC has provided a forum for member states to share data, participate in collaborative learning, and advocate for improved collaboration between the states and the federal government on primary care transformation. The implementation of the ACA may have focused much attention on insurance provisions, but the real challenges and opportunities for health reform lie in improving the performance of the medical care delivery system.

Read the Executive Summary and Report.

The Milbank Quarterly's Impact Factor Score Goes Up—Over 5

The 2013 Institute for Scientific Information (ISI) Impact Factors were recently released—and The Milbank Quarterly had a great year.

The ISI impact factor is the industry standard—and measures the number of citations a journal receives in a given year to research and review articles published in the previous two years. For 2013, the Quarterly had an impact factor of 5.061, an increase of .417 (the Impact Factor was 4.644 last year). It received 2,531 citations to all articles during the 2013 impact factor period, an increase of over 200 citations from the preceding year. The Quarterly remains 1st out of... Read more

THE VIEW FROM HERE: Learning Chinese

Christopher F. Koller, President of the Milbank Memorial Fund

"Physicians at my hospital are retiring. Younger doctors are exploring opportunities in other regions where they can make more money. I can't recruit new physicians. If my rates from payers don't improve, I won't have any providers to see patients."

When I was Health Insurance Commissioner in Rhode Island reviewing proposed rate increases from insurers, I regularly heard complaints like these. But this wasn't a public meeting on rate increases. It was a health systems symposium in Taiwan where I was a week-long guest of the Ministry of Health and Welfare; and the speaker was a hospital administrator, pleading his case to Taiwan's National Health Insurance Administration (NHIA), the group that oversees that country's health insurance system. Allocating scarce resources, it seems, is a universal problem.

Since 1995, the Taiwanese have systematically implemented a single-payer financing system with a mostly private delivery system. The results are impressive. The Taiwanese have longer life spans than Americans (an average of 80.6 years vs 79.8, according to the World Health Organization), yet spend one-third the GDP as the United States on health care. More than 99% of the population carries an NHIA card that guarantees a standard set of benefits. With it, providers can verify enrollment at time of service, confirm recent medical services, and get paid the next day. The Taiwanese enjoy unlimited provider choice and see doctors at higher rates than those in the United States.

But all is not rosy on the island. Concerns about... Read more

New Issue Brief: Exploring Claims That Medicaid Doesn't Improve Health

In debates over Medicaid expansion, several recent studies are often cited as evidence regarding Medicaid's effectiveness and inability to improve population health. The Milbank Memorial Fund (MMF) was asked to assess these studies for policymakers, at the request of the MMF's Reforming States Group (RSG), a bipartisan, voluntary group of health policy leaders from both the executive and legislative branches who convene regularly to share information and experiences, develop professional networks, and work on practical solutions to pressing problems in health care. The studies are a review of insurance claims data on surgical cases, a randomized study of clinical outcomes in Medicaid recipients in Oregon, and an analysis of emergency department use in Medicaid recipients in Oregon.

Read the Issue Brief.



About the Milbank Memorial Fund

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. Founded in 1905, the Fund engages in nonpartisan analysis, collaboration, and communication on significant issues in health policy. It does this work in three ways: publishing high-quality, evidence-based reports, books, and The Milbank Quarterly, a peer-reviewed journal of population health and health policy; convening state health policy decision makers on issues they identify as important; and building communities of health policymakers to enhance their effectiveness. www.milbank.org.

 

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