A Road Map For Action: Recommendations Of The Health Affairs Council On Health Care Spending And Value

“The twenty-two-member council is a nonpartisan, multidisciplinary expert working group under the leadership of cochairs William Frist [former US Senate majority leader] and Margaret Hamburg [former commissioner of the Food and Drug Administration]. This report contains the council’s recommendations. [..] The goal of the recommendations in this report is to achieve higher-value health care spending and growth in the US. The mechanism for achieving this goal involves four levers: The council examined literature and received input from experts in its inquiry into drivers of spending and growth that met the following criteria: a meaningful amount of money is potentially at … Read More

Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake

“The perpetual diet wars between factions promoting low-carbohydrate, keto, paleo, high-protein, low-fat, plant-based, vegan, and a seemingly endless list of other diets have led to substantial public confusion and mistrust in nutrition science. While debate rages about the relative merits and demerits of various so-called healthy diets, less attention is paid to the fact that otherwise diverse diet recommendations often share a common piece of advice: avoid ultra-processed foods. [..] The rise in obesity and type 2 diabetes prevalence occurred in parallel with an increasingly industrialized food system characterized by large-scale production of high-yield, inexpensive, agricultural “inputs” (primarily corn, soy, … Read More

The New Hospital at Home Movement: Opportunity or Threat for Patient Care?

Select Key Findings Policy Issues Debating the Future: Does H@H Save Costs and Improve Patient Care? “[..] Recent studies of cost savings from H@H programs range from 20 percent (Reese 2021) to 40 percent (Brigham and Women’s Hospital in Boston, Levine et al. 2020). But these findings are not generalizable as they are based entirely on single case studies of highly structured programs involving small samples of very carefully selected patients. For example, the study of Brigham and Women’s program examined 91 adults who were admitted to the hospital’s ED and randomly assigned to the hospital vs home for treatment. [..] While … Read More

Can Employer-sponsored Insurance Be Saved? A Review of Policy Options: Price Regulation

“[..] spending on hospital care makes up the largest single component of personal health care spending, an estimated 39 percent of the total in 2023, compared to 24 percent for physician and clinical services and 10 percent for prescription drugs. National spending on hospital care is projected to exceed $1.5 trillion in 2023, and is expected to grow by about 5.6 percent per year over the coming decade (a rate likely to significantly exceed general inflation). Much of this growth is driven by consolidation among hospitals and health systems, which then use their size and local market power to demand … Read More

Risk Adjustment And Promoting Health Equity In Population-Based Payment: Concepts And Evidence

“[Introduction] [..] population-based payment models, as in the Medicare Shared Savings Program or Medicare Advantage (MA) program, can facilitate the resource reallocations necessary to address health care disparities. Risk adjustment is the mechanism by which payment is allocated in these models. Traditionally, risk adjustment has been conceived and executed purely as a predictive exercise. Regression is used to predict total annual per person spending as a function of demographic and clinical characteristics. A person’s predicted spending is converted to a risk score, which is applied to a base regional rate to determine the prospective payment or benchmark for that person. … Read More

Advancing the commercial determinants of health agenda

“By the 1990s, worsening patterns of population health began to raise concerns about their association with these changes in the global political economy. The sharp rise in non-communicable diseases, now accounting for 74% of deaths worldwide, were difficult to explain solely as related to individual behavioural choices. The links between population health outcomes, the strategies and products of corporations, and the political contexts that facilitate such practices began to receive closer scrutiny. Over the next two decades, detailed analyses of an increasingly globalised tobacco industry, enabled by a flood of internal documents into the public domain, were followed by similar … Read More

Corporate Investors in Primary Care — Profits, Progress, and Pitfalls

“driven by an increasing focus on “total-cost value-based care” — a model in which health care providers are paid to manage the total cost of care for their patients and the size of each patient’s capitated budget may be increased on the basis of the patient’s health risks and the provider’s performance on quality metrics. Though potentially beneficial for certain well-insured patients, the trend of corporate investment in primary care could threaten equitable access to care, raise health care costs, and reduce physicians’ clinical autonomy. [..] As Medicare and commercial payers move toward total-cost value-based payments, such as capitation, and … Read More

Unhealthy histories: sports and addictive sponsorship

“Professional sport has been criticised for its role as a vehicle to market addictive products or services. Despite the harmful health effects on society, football audiences are inured to seeing sponsors of such products not only on pitch-side hoardings and shirts, but also embedded in television rights, competition names, prematch build-up, corporate hospitality, and social media. Tobacco’s successful movement into sports sponsorship established the template on which other addictive sponsors, notably the alcohol and gambling industries, built their strategies. The integration of sports and addictive commodities highlights strategies to influence consumption by those within the unhealthy commodities industry. [..] historically … Read More

Price Transparency in Hospitals—Current Research and Future Directions

“There are 3 main takeaways from the existing research on the rule. First, the compliance rates have been low. In March 2021, a random sample of 100 hospitals indicated that only 33% reported the negotiated commercial prices for some services. [..] In response to the low compliance, the CMS raised the penalty for noncompliant hospitals to $300 per day for small hospitals and up to $5500 per day for large hospitals beginning from January 1, 2022. Despite the steeper penalties, the compliance rate remains low. For example, Gul et al note that as of March 2022, only 29% to 56% … Read More

Value-based payment has produced little value. It needs a time-out

“The concept of value-based payment became widespread among U.S. health policymakers and analysts during the 2000s. It collectively refers to interventions that offer doctors and hospitals financial incentives that, in theory, induce them to improve both components of health-care value — cost and quality — without generating the hostility provoked by managed care insurance companies during the HMO [health maintenance organization] backlash of the late 1990s. [The Center for Medicare and Medicaid Innovation reviewed 54 models of value-based payment. Only four were certified to be expanded:] The Home Health Value-based Purchasing Model demonstration cut Medicare spending by 1% with mixed … Read More