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As the COVID-19 pandemic wound on, 2021 proved another unpredictable and challenging year for public health and health care. Our top 10 most-read publications of 2021 (not including Milbank Quarterly articles) reflect some of the year’s trends, including bolstering the community health worker profession, paying for care that encompasses social needs, and supporting older adults, particularly to enable aging in community settings. Other popular pieces considered state efforts to address health care market consolidation and how best to measure primary care spending and engage Medicaid agencies in federal primary care transformation efforts. We hope you’ll check out these papers — or dip into them again.
Scaling up the role of community health workers (CHWs), as recommended by President Biden during his campaign, will require significant workforce development to address the lack of a CHW career pipeline and high rates of turnover. Olenga Anabui and colleagues at the Penn Center for Community Health Workers explored CHW perspectives on job satisfaction and career advancement to inform a career development program that promotes equitable, transparent, and sustainable advancement within the CHW profession.
It is accepted that the movement toward value-based care offers opportunities to address social determinants of health while improving value and quality of care. But what are the best practices for implementation, impacts on costs, and next steps? To answer these questions, Hannah L. Crook, James Zheng, William K. Bleser, and colleagues summarize and assess the landscape of payment reform initiatives addressing SDoH in this issue brief copublished with the Duke-Margolis Center for Health Policy. The authors draw on a systematic review of the literature as well as scans of state health policies and proposed payment reform models.
At least two million older adults who are unable to leave their homes face challenges in accessing the COVID-19 vaccine. In this blog post, John Auerbach and Megan Wolfe of Trust for America’s Health say that solving the problem would require four key steps: 1) identifying the population, 2) securing the needed vaccines, 3) contracting with the organizations that can provide the home visits to administer the vaccines, and 4) covering their costs.
Early COVID-19 outbreaks in nursing homes put a spotlight on the long-standing problems with how our nation delivers long-term services and supports and health care to older Americans. The American Rescue Plan Act (ARPA) can help state officials address the needs of older adults through its temporary increase in the federal match for certain Medicaid home- and community-based services spending. In this issue brief, Health Management Associates’ Madeleine Shea and Aaron Tripp provide an overview of key direct and indirect ARPA provisions that could be leveraged to support older adults.
Multipayer primary care demonstration projects are using value-based payment and care delivery reforms to improve care quality and reduce unnecessary emergency department and inpatient utilization. But what precisely makes a difference in primary care? To identify specific interventions and practice characteristics that are associated with high-performing practices, Diane Marriott of the University of Michigan and Jerome Finkel of the Henry Ford Health System conducted in-depth interviews with high-performing practices in Michigan.
Addressing growth in health care spending requires a system-wide approach to data transparency and the active participation of payers and other stakeholders. This Peterson-Milbank Program for Sustainable Health Care Costs case study by Erin Taylor, Michael Bailit, Megan Burns, and Justine Zayhowski of Bailit Health explores how Rhode Island set and implemented its cost growth target. The authors offer key takeaways on each phase of the process, which other states can use to inform the design and implementation of their cost growth initiatives.
Increasingly, hospitals have merged to form dominant health systems that can exert market power and charge anticompetitive prices, which reduce wage growth and burden the economy. In this issue brief, Katherine L. Gudiksen, Alexandra D. Montague, and Jaime S. King of The Source for Healthcare Price and Competition describe actions taken by federal and state policymakers to address the consequences of health care provider concentration through increased price transparency, improved merger review, oversight of anticompetitive conduct, and increased competition through a public option.
The COVID-19 pandemic has taken a disproportionate toll on racial and ethnic minority populations in the United States. Many Medicaid programs today are addressing not only COVID-19–related racial and ethnic health disparities but also health disparities by income, geography, and other factors. In this issue brief funded through the Medicaid Evidence-based Decisions Project (MED), Aasta Thielke, Pam Curtis, and Valerie King of the Center for Evidence-based Policy outline a two-pronged approach that Medicaid programs are using to address disparities.
Nationally, Medicaid payments represent approximately 44% of all spending on long-term services and supports. A primer by Allyson Evans and Valerie King of the Center for Evidence-based Policy at Oregon Health & Science University examines the financial and policy levers available to states to encourage managed care organizations (MCOs) to provide care in more cost-effective home- and community-based settings, which beneficiaries often prefer.
Over the last 20 years, the Centers for Medicare and Medicaid Services has launched three primary care models designed to align multiple payers with Medicare: Comprehensive Primary Care, Comprehensive Primary Care Plus, and Primary Care First. State Medicaid agencies can be valuable participants in these models given that they are among the largest health care payers in a market and are a driver of a state’s health policy. This issue brief by Greg Howe, Anne Smithey, and Rob Houston of the Center for Health Care Strategies examines state Medicaid agencies’ decision-making around participating in federal models.
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