Journal of the American Medical Association: Relationship of Primary Care Physicians' Patient Caseload With Measurement of Quality and Cost Performance – To "determine whether primary care physicians in the same physician practice collectively see enough Medicare patients annually to detect meaningful differences between practices in ambulatory quality and cost measures," the authors of this study combed through a national sample of Medicare beneficiaries and a database identifying the practice affiliations of the physicians who delivered care to these patients. "In the absence of performance measurement approaches that amass larger numbers of eligible patients at the physician or practice level, the results from this study call into question the wisdom of pay-for-performance programs and quality reporting initiatives that focus on differentiating the value of care delivered to the Medicare population by primary care physicians," the authors conclude. "Novel measurement approaches appear to be needed for the twin purposes of performance assessment and accountability" (Nyweide, Weeks, Gottlieb, Casalino and Fisher, 12/9).
Kaiser Family Foundation: Health Insurance Coverage for Older Adults: Implications of a Medicare Buy-In - This policy brief "provides an updated profile of the more than 4 million uninsured people between ages 55 and 64 and examines historical proposals to allow uninsured older adults to purchase Medicare coverage. It also examines barriers to securing affordable coverage in the current marketplace, and the effect of premiums and eligibility criteria on the potential uptake of a Medicare buy-in" (Jacobson, Schwartz and Neuman, 12/10).
Health Affairs: Taxing Cadillac Health Plans May Produce Chevy Results – "It’s often assumed that high-cost health insurance plans—sometimes called "Cadillac" plans—provide rich benefits to plan subscribers. Health reform provisions that treat these plans like luxuries may be misguided. Only 3.7 percent of variation in the cost of family coverage can be explained by benefit design (actuarial value). Benefit design plus plan type (HMO, PPO, POS, or high-deductible plans) explains 6.1 percent of this variation. Industry type and medical costs in the region also play a role. Most variation in premiums, however, remains largely unexplained." The authors analyzed data from the 2007 Kaiser Family Foundation/Health Research and Educational Trust (KFF/HRET) Employer Benefits Survey (Gabel, Pickreign, McDevitt and Briggs, 12/3).
Robert Wood Johnson Foundation: Post Claims Underwriting and Rescission Practices – This report examines the individual insurance market through case studies of regulation practices in California, Connecticut, Florida and Texas. In addition to highlighting the existing gaps in consumer protection in each state, the brief offers "recommendations for federal policymakers seeking to transform health insurance markets including: To the extent states continue to regulate insurance under health reform, state laws must clearly and consistently reflect the federal standards; Direct outreach and support on consumer rights must be expanded; Regulators must collect more detailed data about the health insurance markets they regulate and use specific criteria on when to carry out a market conduct review" (Harbage, Haycock, Ledford and Harbage Consulting, 12/04).
Kaiser Family Foundation: What’s in the Stars? Quality Ratings of Medicare Advantage Plans, 2010 – To assess the variation in the quality ratings of the 2010 private plans offered to Medicare beneficiaries under the Medicare Advantage Plan, the authors of this issue brief (.pdf) examined the CMS' five-star rating system and additional information from the CMS Plan Directory and enrollment files. "Almost one in four Medicare Advantage enrollees nationwide are in plans that received four or more stars, but enrollment in plans with four or more stars varies greatly by state," according to the brief. "With one in five Medicare Advantage enrollees in plans with fewer than three stars, policymakers may want to focus greater oversight and attention on plans with relatively low quality ratings," the authors conclude (Jacobson, Damico, Neuman and Huang, 12/7).
Urban Institute: Applying 21st-Century Eligibility and Enrollment Methods to National Health Care Reform – This brief (.pdf) examines the viability of using the federal income tax system to identify the uninsured and enroll them into coverage without application forms. "Without any need to wait for uninsured consumers to complete application forms, most Americans without coverage would rapidly be enrolled in insurance, receiving subsidies based on data matches with tax records," the author of the brief writes. The brief also details the success of other federal programs that have used tax information to qualify for need-based assistance, the limitations of using prior-year tax data and the need for back-up enrollment methods (Dorn, 12/1).