Tuesday, December 15, 2015

Health Reform: Unfinished Work and Leadership According to NEJM

The December 17 New England Journal of Medicine contains one noteworthy article and one editorial on health reform.


The article is by Benjamin Sommers, MD, of the Department of Health Policy and Management at the Harvard School of Public Health.

It is titled “Health Care Reform’s Unfinished Work – Remaining Barriers to Coverage and Access.”

It sets forth these changes in composition of Uninsured between 2010 and 2015

Uninsured in 2010: 50 million.

Now newly insured

• Young adults, 19 to 25 years of age, under parents’ plan: 2 million to 3 million.

• Those now insured through health exchanges and Medicaid. 14 million to 16 million.
Total : 16 million to 19 million

Uninsured in 2015: 30 million to 34 million

• Uninsured likely to be eligible for ACA-subsidized coverage: 15 million to 17 million.

• Uninsured with income too high for ACA subsidies or ineligible owed to employer coverage: 5 million to 7 million.

• Uninsured poor adults in non-expansion states: 3 million to 4 million.

• Uninsured undocumented immigrants; 5 million to 6 million.

The article then moves on to the challenges that that remain, which it describes as:

“Liberals who believe a single-payer system is the easiest method of eliminate cracks in our patchwork coverage approach must face the political realities that derailed a single-payer effort in liberal Vermont and have made it so challenging to implement even a centrist national health care reform law. Many conservatives still advocate ‘repeal and replace,’ but the almost-certain backlash against taking coverage away from 15 million Americans make it hard to imagine this rhetoric becoming reality, even if Republicans control Congress and the White House after 2016.”

The author clearly favors the liberal approach and thinks it will be adapted just as Medicare and Medicaid have been.

The editorial is by Thomas Lee, MD, Edward Campion, MD, Stephen Morrissey, PhD, and Jeffrey Drazen, MD, all from the editorial staff of NEJM .

It is titled “Leading the Transformation of Health Care Delivery – The Launch of NEJM Catalyst.”

The NEJM Catalyst is a “resource’ will “provide health care leaders with information to provide these leaders with information that can help them redesign patient care, change the structure of their institutions, contemplate new relationships with outside organizations, and reconsider the ways in which incentives are being used.”

The NEJM Catalyst will have 4 overlapping themes.

1) The “New Marketplace,” which will focus on health policy and markets impacts on payer and provider consolidation, value-based payment, competition and consumer choice.

2) “Care Redesign” which will concentrate on how to create and sustain the teamwork needed to provide high-value care, and the practical ways of organizing care to enhance health as well as sick care.

3) “Patient Engagement: Behavioral Strategies for Better Health.” This will focus on what is known about the use of incentives (financial and non-financial ) to engage patients in improving their own health.

4) “Leadership.” This will be about engaging clinicians in to enhance the value of care .

These NEJM insights will draw on the expertise of clinicians, clinical leaders, and health care executives from across the country.

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