Blog: The View from Here

  • Getting More Primary Care Oriented: Measuring Primary Care Spending

    Jul 31, 2017 | Christopher F. Koller, President

    We all have our obsessions. Many are best not shared, although sometimes airing them is helpful, especially when they are informed by research. One of my persistent professional preoccupations is the US health care system’s stubborn aversion to orient itself to the fundamental importance of primary care. Fortunately, I am not alone in being somewhat haunted by this issue—and a new report by … Read more

  • Total Health Care Spending by State: Wide Variations in Amounts and Trends

    Jun 20, 2017 | Christopher F. Koller, President

    The game of hot potato ends one of two ways—someone drops the potato as it is being tossed or it finally cools off.  But what happens if the potato stays hot? How long can you get everybody to keep playing catch?  How do you get it to cool off? We are playing hot potato with health care costs in the United States—shifting them to whomever we can. Some new analyses on health care spending … Read more

  • Medicaid Costs, Medicaid Benefits

    May 30, 2017 | Christopher F. Koller, President

    Like rising sea levels, Medicaid costs are flooding state and federal budgets. Medicaid reform efforts, such as those in the American Health Care Act (AHCA), promise more flexibility to states to take on these Medicaid cost challenges. They need, however, to be viewed with caution by state policymakers: addressing the problem should not involve leaky sandbags or throwing people into the … Read more

  • Competence in Government Is Not a Partisan Issue

    Apr 27, 2017 | Christopher F. Koller, President

    We should expect competence as public policies are planned and implemented. Frequently, with state health policies, we get it: heroic responses by public workers reacting to environmental emergencies or outbreaks of infectious diseases; well-executed outreach and enrollment of large populations newly eligible for public programs; well-coordinated and persistently implemented efforts to tackle poor … Read more

  • “Acceptably Cruddy:” The Art of the (Health Care) Deal

    Mar 30, 2017 | Christopher F. Koller, President

    Finding dissenting opinions in a public health class on policy priorities for the US health system is like looking for stars in the night sky of a city—you know they exist in the bigger world, but they are nowhere to be found in the current setting.  Universal health insurance? Heck yes! Centers for Disease Control and Prevention and Agency for Healthcare Research and Quality? Fully funded! … Read more

  • Trending Now: Learning from Medicaid Spending

    Feb 27, 2017 | Christopher F. Koller, President

    From 1997 to 2005, I ran Neighborhood Health Plan of Rhode Island (NHPRI), the state’s largest Medicaid managed care organization. We worked hard to help coordinate high-value health care and we thought we did pretty well. Recently compiled Medicaid spending data, however, points out that success for states may not mean success for the federal government, and might explain why the state-federal … Read more

  • Taking the Long View on Health Care – A Note to Congress

    Jan 25, 2017 | Christopher F. Koller, President

    Dear Members of Congress: As both Houses continue to debate whether and how the Affordable Care Act (ACA) should be repealed and what it would be replaced with, let me suggest three considerations for discussion. 1) Health Insurance Matters. Your primary goal should be to get as many people covered as possible. That coverage should give Americans assurance that if they get sick they will … Read more

  • State Flexibility? How about a Real Partnership?

    Dec 22, 2016 | Christopher F. Koller, President

    In the aftermath of the November elections, we at the Fund had a chance to speak in person to over 125 state health policy leaders as we held meetings of our Reforming States Group (RSG).  With all the talk of “increased state flexibility” in federal health policy, were state leaders relishing the prospect of  freedom from the shackles of restrictive federal standards—and eager to innovate … Read more

  • ACA Winners and Losers

    Nov 28, 2016 | Christopher F. Koller, President

    Congress is preparing to debate the future of the Affordable Care Act (ACA) yet again. While “repeal and replace” may take longer than was promised on the election trail, with single party control of both Congress and the White House, changes to the ACA appear inevitable. As they sort through particular policy proposals, lawmakers should take into highest account the concerns of those most … Read more

  • Steady Progress in Multi-Payer Primary Care Transformation

    Oct 26, 2016 | Christopher F. Koller, President

    CO-AUTHORED WITH LISA DULSKY WATKINS The release on October 17, 2016 of 2015 Shared Savings and Quality Results for year two of the Center for Medicare and Medicaid Innovation’s (CMMI) Comprehensive Primary Care (CPC) Initiative marked another milestone in efforts to align payers and transform primary care.  Observers looking for an airtight identification of the right mix of payment, … Read more