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County Health Rankings Show People Living in Least Healthy Counties Twice as Likely to Have Shorter Lives than People Living in Healthiest Counties

March 26, 2014 Comments off

County Health Rankings Show People Living in Least Healthy Counties Twice as Likely to Have Shorter Lives than People Living in Healthiest Counties
Source: Robert Wood Johnson Foundation

The fifth edition of the County Health Rankings released today continues to show us that where we live matters to our health. Large gaps remain between the least healthy counties and healthiest counties. For instance, the least healthy counties have twice the death rates and twice as many children living in poverty and teen births as the nation’s healthiest counties.

A collaboration between the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute (UWPHI), the County Health Rankings allow each state to see how its counties compare on 29 factors that impact health, including smoking, high school graduation rates, unemployment, physical inactivity, and access to healthy foods. The Rankings are available at www.countyhealthrankings.org.

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Navigator Resource Guide on Private Health Insurance Coverage & the Health Insurance Marketplace

March 12, 2014 Comments off

Navigator Resource Guide on Private Health Insurance Coverage & the Health Insurance Marketplace
Source: Georgetown University Center on Health Insurance Reform and Robert Wood Johnson Foundation

This guide is focused solely on the private insurance reforms of the Affordable Care Act, including the health insurance marketplaces, rating, benefit and cost standards, and premium tax credits. It is intended to supplement the Navigator training available from the U.S. Department of Health and Human Services. It is not intended to be a comprehensive, stand-alone resource for all the reforms of the Affordable Care Act.

This resource is organized into sections that address how individuals may present themselves to Navigators, based on their insurance status and coverage options.

► Section 1 covers enrollment issues for individuals, beginning with those who do not have coverage or an offer of group coverage, i.e., from an employer.

► Section 2 covers enrollment issues for individuals who have coverage or an offer of coverage—whether through an employer-sponsored plan, individual plan, high-risk pool, retiree plan, or student health plan—and want to understand their options, including eligibility for premium tax credits through the health insurance marketplace.

► Section 3 covers enrollment issues for small employers who want to understand and compare their coverage options for their employees.

► Section 4 covers post-enrollment issues, including questions that may arise as individuals use their coverage.

Information in this guide is current as of February 21, 2014. Future supplements will incorporate changes to federal rules. While we have made every effort to provide accurate information in this resource guide, navigators should contact their state’s marketplace, Department of Insurance, or Medicaid agency for guidance on specific circumstances.

New Brief on Data Collection and Use in Health Insurance Exchanges

February 7, 2014 Comments off

New Brief on Data Collection and Use in Health Insurance Exchanges
Source: George Washington University School of Public Health/Robert Wood Johnson Foundation

This brief, written by Taylor Burke, Lara Cartwright-Smith, and Sara Rosenbaum, discusses the new health insurance marketplaces created under the Affordable Care Act and associated structural and process-related regulations that aim to ensure the quality and value of plans sold. To qualify to be sold in these marketplaces, new plans must be certified as a “Qualified Health Plan” (QHP), meet quality accreditation standards, and implement a quality improvement strategy. These steps require the collection of information from insurers, which will result in the disclosure of information about health insurance policies, practices, cost, and quality. Learn more about QHP certification and accreditation and the impact these processes will have on the public availability of health plan performance data…

Caring for Health Care’s Costliest Patients; Communities Find Ways to Identify and Treat ER ‘Super-Utilizers’

January 17, 2014 Comments off

Caring for Health Care’s Costliest Patients; Communities Find Ways to Identify and Treat ER ‘Super-Utilizers’
Source: Robert Wood Johnson Foundation

Super-utilizer patients fall into several different categories—from patients with chronic conditions to those who struggle with behavioral health needs that impede their ability to engage in self-care, to frail elderly patients.

In some instances, addressing health care needs isn’t enough on its own—some patients may lack access to phones for providers to check in on them, while others may have trouble keeping their lights on. Some are isolated because they live in remote areas or lack a network of family and friends nearby.

Medicare Hospital Readmissions Reduction Program

December 5, 2013 Comments off

Medicare Hospital Readmissions Reduction Program
Source: Robert Wood Johnson Foundation

Policy-makers are constantly searching for ways to improve the quality of patient care and lower Medicare program spending.

One indicator of inadequate quality that results in increased Medicare spending is the rate of readmissions to a hospital.

Readmission refers to a patient being admitted to a hospital within a certain time period from an initial admission. In the context of Medicare, readmissions have been generally defined as a patient being hospitalized within 30 days of an initial hospital stay. If a hospital has a high proportion of patients readmitted within a short time frame, it may be an indication of inadequate quality of care in the hospital or a lack of appropriate coordination of postdischarge care. Although not all readmissions can be prevented, research shows that there are strategies that hospitals can employ to avert many readmissions.

This brief describes the Medicare Hospital Readmissions Reduction Program (HRRP) established in the Affordable Care Act (ACA) that provides a financial incentive to hospitals to lower readmission rates. Although the program has been in operation for only few years, initial results show potential. A number of technical issues in the program design have been identified and are being addressed by the Centers for Medicare and Medicaid Services (CMS) through the administrative process. However, there are also concerns about potential flaws in the program’s methodological approach. Others fear unintended consequences for safety-net hospitals that may threaten care for vulnerable populations.

The Dartmouth Atlas of Medicare Prescription Drug Use

October 18, 2013 Comments off

The Dartmouth Atlas of Medicare Prescription Drug Use
Source: Robert Wood Johnson Foundation

Key Findings

  • The average Medicare patient enrolled in Part D filled 49 standardized 30-day prescriptions in 2010; however, the number of prescriptions filled per patient across hospital referral regions varied by a factor of more than 1.6.
  • Effective prescription drug care fell below optimal levels in most hospital referral regions for heart attack survivors and diabetes patients.
  • The proportion of beneficiaries receiving two or more discretionary medications among region at the 10th and 90th percentile was 10.3 percent to 16.4 percent.
  • The use of distinct drugs targeting clinically unrelated diseases is highly correlated.

Quality Field Notes: Reducing Inappropriate Emergency Department Use

September 30, 2013 Comments off

Quality Field Notes: Reducing Inappropriate Emergency Department Use
Source: Robert Wood Johnson Foundation

Hospital emergency departments (EDs) are indispensable to the acute health care system. Yet, 70 percent of ED visits are not emergencies or could be prevented with effective and timely outpatient care. EDs offer convenient access to care after-hours and for people without a regular primary care physician, and until recently, most insurance plans did not discourage their use.

Patient demand for EDs is increasing, even as the number of hospitals with EDs is decreasing, leaving patients concentrated in more crowded EDs. Looking ahead, the aging population and growing burden of chronic disease will continue to put a strain on both primary care providers and EDs.

Lessons from AF4Q demonstrate how:

  • Simple, gradual and targeted efforts to improve collaboration and communication with providers and patients can make all the difference in reducing ED use.
  • Data transparency on the use of health services can help identify avoidable ED use and the reasons behind it.
  • Initiatives to engage stakeholders to take action should involve working with them, not just talking to them.

Trends in Cancer Care Near the End of Life

September 12, 2013 Comments off

Trends in Cancer Care Near the End of Life
Source: Robert Wood Johnson Foundation

Even though most patients with advanced cancer prefer care that minimizes symptoms, many still receive intense treatment and are not admitted into hospice care until their last three days of life, according to research from the Dartmouth Atlas Project. Although hospice care for Medicare patients with advanced cancer is increasing, so are the rates of treatment in intensive care units.

Since the last Dartmouth Atlas report, the trends in end-of-life cancer care across the country have been mixed. While patients are spending fewer days hospitalized in the last month of life, the number of days in ICUs has increased. Hospice days have also increased, but a growing proportion of patients begin receiving hospice services in the last three days of life, a time period often too short to provide patients the full benefit of hospice care.

Moving to High Quality, Adequate Coverage: State Implementation of New Essential Health Benefit Requirements

August 14, 2013 Comments off

Moving to High Quality, Adequate Coverage: State Implementation of New Essential Health Benefit Requirements
Source: Robert Wood Johnson Foundation

Beginning in January of 2014, insurance companies offering plans in the insurance exchanges created by the Affordable Care Act must adhere to regulations establishing ‘essential health benefits.’

A new report looks at how insurance companies and state governments in various states are dealing with the new regulations and highlights the struggles and successes they have experienced to date.

Key Findings

  • Technical glitches and tight deadlines posed challenges for insurers and regulators alike, but an “all hands on deck” mentality and commitment to consumers have kept the process moving forward.
  • Officials in all but one of the states analyzed reported that they have had good communication with the federal government regarding plan management and oversight.
  • Insurers and regulators in most study states reported that the shift to an essential health benefit standard would cause minimal change or disruption, while in one state it would result in a significantly expanded set of benefits for individual policyholders.
  • Insurers are engaging in minimal substitution of covered benefits in the first year, meaning that plans will closely resemble the benefits, limits, and exclusions prescribed in the benchmark package, with differences primarily reflected in cost-sharing and network design.
  • One study state is facilitating consumers’ ability to make “apples-to-apples” plan comparisons by standardizing benefit designs inside and outside the exchange.

Economic and Community Development Benefits of Healthy Food Retail

June 21, 2013 Comments off

Economic and Community Development Benefits of Healthy Food Retail

Source: Robert Wood Johnson Foundation

For more than two decades, researchers have been gathering evidence to determine whether there are connections between access to healthy food and decreased obesity rates and other diet-related diseases. In general, research shows that when communities have access to affordable, healthy foods, residents purchase and consume healthier foods over time. But improving access to healthy foods, especially in lower-income communities and communities of color in both rural and urban settings goes beyond improving diet and health outcomes: Bringing new food outlets into underserved areas also can provide an economic stimulus in communities that may need it most.

Doing Better by Doing Less: Approaches to Tackle Overuse of Services

June 12, 2013 Comments off

Doing Better by Doing Less: Approaches to Tackle Overuse of Services

Source: Urban Institute/Robert Wood Johnson Foundation

This Robert Wood Johnson Foundation-funded analysis presents what we know about the provision of medically inappropriate and unnecessary services that drive up health care spending without making a positive impact on patients’ health outcomes. It also describes approaches that have already been used to address this issue—with limited success. We suggest that broader payment reforms are needed to minimize incentives to overdiagnose and overtreat and to better support the other approaches.

The Aligning Forces For Quality Experience: Lessons On Getting Consumers Involved In Health Care Improvements

June 6, 2013 Comments off

The Aligning Forces For Quality Experience: Lessons On Getting Consumers Involved In Health Care Improvements

Source: Health Affairs

Aligning Forces for Quality is the Robert Wood Johnson Foundation’s signature effort to improve the overall quality of health care in targeted communities, reduce racial and ethnic disparities in care, and provide models for national reform. Activities in each of the sixteen Aligning Forces for Quality alliance communities are guided by a multistakeholder alliance of consumers, providers, and payers. To achieve goals established at the national and local levels, the alliances integrate local consumers into governance and decision making, program design and implementation, and information dissemination efforts. This article describes how the Aligning Forces for Quality investments have evolved since the initiative’s launch in 2006 and offers some early lessons learned. Individual alliances have engaged consumers in numerous capacities, from serving on dedicated consumer advisory boards to representing the consumer’s perspective in the design of public reports of providers’ quality. The alliances’ ongoing and mindful inclusion of consumers provides insights into eliciting and applying their perspectives in the pursuit of improved health care quality, value, and transparency.

Preserving Medicare for Future Generations: Market-Based Approaches to Reform

April 22, 2013 Comments off

Preserving Medicare for Future Generations: Market-Based Approaches to Reform

Source: American Enterprise Institute via Robert Wood Johnson Foundation

These Robert Wood Johnson Foundation-supported reports from the American Enterprise Institute highlight market-based solutions to Medicare’s sustainability crisis and the inherent inefficiencies of the current system.

The nonpartisan Congressional Budget Office (CBO) projects the cost of providing benefits to Medicare enrollees will increase at an annual growth rate of 7 percent, reaching at least $1 trillion in fiscal year 2022.

America’s fee-for-service Medicare program represents the third-largest category of federal spending and has been under scrutiny for decades for spending more on health care benefits for enrollees than taxes can generate to pay for them. The CBO estimates that over the next 10 years, the number of Medicare enrollees will increase by one-third—approaching 67 million Americans.

Uninsured Veterans and Family Members: Who are They and Where Do They Live?

February 11, 2013 Comments off

Uninsured Veterans and Family Members: Who are They and Where Do They Live?
Source: Robert Wood Johnson Foundation

One in 10 of the nation’s 12.5 million nonelderly veterans report either not having health insurance coverage or using Veterans Affairs (VA) health care, according to the 2010 American Community Survey (ACS). This report, prepared by the Urban Institute and released by the Robert Wood Johnson Foundation, is the first-ever to provide estimates of uninsurance among veterans and their families both nationally and at the state level, and to assess the potential for the Affordable Care Act (ACA) to reduce their uninsurance rates.

Veterans are less likely than the rest of the nonelderly population to be uninsured. Both uninsured veterans and their family members report significantly less access to health care than their counterparts with insurance coverage.

How to Avoid Being Readmitted to the Hospital

February 1, 2013 Comments off

How to Avoid Being Readmitted to the Hospital

Source: Robert Wood Johnson Foundation

Leaving the hospital sounds simple. But all too often, people find themselves back at the hospital within only a few weeks. With better planning and better communication, many of these return visits can be avoided. This fact sheet from Care About Your Care can help patients take steps to avoid being readmitted.

  • Ask and ask again
  • Say it back
  • Have a discharge plan
  • Manage your medications
  • Keep appointments
  • Know what to do if you don’t feel well

See also:
Care About Your Care Discharge Checklist & Care Transition Plan
Ten Things You Should Know About Care Transitions
Reducing Avoidable Readmissions Through Better Care Transitions

Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism

January 13, 2013 Comments off

Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism

Source: Trust for America’s Health, Robert Wood Johnson Foundation

In the 10th annual Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism report, 35 states and Washington, D.C. scored a six or lower on 10 key indicators of public health preparedness.

The report found that while there has been significant progress toward improving public health preparedness over the past 10 years, particularly in core capabilities, there continue to be persistent gaps in the country’s ability to respond to health emergencies, ranging from bioterrorist threats to serious disease outbreaks to extreme weather events.

In the report, Kansas and Montana scored lowest – three out of 10 – and Maryland, Mississippi, North Carolina, Vermont and Wisconsin scored highest – eight out of 10.

Adult Obesity Rates Could Exceed 60 Percent in 13 States by 2030, According to New Study

September 18, 2012 Comments off

Adult Obesity Rates Could Exceed 60 Percent in 13 States by 2030, According to New Study

Source: Robert Wood Johnson Foundation

The number of obese adults, along with related disease rates and health care costs, are on course to increase dramatically in every state in the country over the next 20 years, according to F as in Fat: How Obesity Threatens America’s Future 2012, a report released today by Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF).

For the first time, the annual report includes an analysis that forecasts 2030 adult obesity rates in each state and the likely resulting rise in obesity-related disease rates and health care costs. By contrast, the analysis also shows that states could prevent obesity-related diseases and dramatically reduce health care costs if they reduced the average body mass index of their residents by just 5 percent by 2030.


If obesity rates continue on their current trajectories, by 2030, 13 states could have adult obesity rates above 60 percent, 39 states could have rates above 50 percent, and all 50 states could have rates above 44 percent.

By 2030, Mississippi could have the highest obesity rate at 66.7 percent, and Colorado could have the lowest rate for any state at 44.8 percent. According to the latest data from the U.S. Centers for Disease Control and Prevention (CDC), obesity rates in 2011 ranged from a high of 34.9 percent in Mississippi to a low of 20.7 percent in Colorado.

Reform in Action: Can Publicly Reporting the Performance of Health Care Providers Spur Quality Improvement?

August 8, 2012 Comments off

Reform in Action: Can Publicly Reporting the Performance of Health Care Providers Spur Quality Improvement?
Source: Robert Wood Johnson Foundation

Aligning Forces for Quality (AF4Q) Alliances have been pioneers in collecting and publicly reporting data on the care provided by local physicians and hospitals, and are beginning to see their impact when it comes to improving quality. The real challenge is turning the idea of transparency into the reality of quality improvement on the ground.

In less than a decade, the push for transparency in health care has come a long way. There are public reports on the quality or cost of care provided by hospitals or physicians in every state except Alaska, Idaho, and the District of Columbia.

Measuring and publicly reporting on the quality and cost of care is crucial to improving quality and lowering health care costs nationwide, and serves three important purposes: 1) it enables patients to make informed choices about their care and be better partners with their doctors; 2) it allows health care professionals to see where they can improve and motivates them to improve their performance; and 3) it allows consumers and purchasers to see the value they are getting for their money.
Aligning Forces for Quality is the Robert Wood Johnson Foundation’s signature effort to lift the overall quality of health care in 16 targeted communities, as well as reduce racial and ethnic disparities and provide tested local models that help propel national reform.

Medicare and Medicaid — Care for Dual Eligibles

June 23, 2012 Comments off

Care for Dual Eligibles
Source: Robert Wood Johnson Foundation

Medicare and Medicaid are the main government programs that provide health insurance to a range of individuals, including the elderly, people with low incomes, and those with certain disabilities. The programs have different funding sources, covered benefits, and management systems.

People who qualify for benefits under both programs, some nine million beneficiaries, are commonly referred to as “dual eligibles.” They frequently have multiple chronic conditions and more than half have cognitive or mental impairments. Yet because of the separate nature of Medicare and Medicaid, care provided to the “duals” is often poorly managed.

The Affordable Care Act created a new Medicare-Medicaid Coordination Office within the Centers for Medicare and Medicaid Services (CMS) in an attempt to make the two programs work together more effectively. The office is testing various approaches to doing so.

This brief describes those efforts and the debate over how they should be structured and how likely they will be to lower costs.

Center to Advance Palliative Care

June 3, 2012 Comments off
Source:  Robert Wood Johnson Foundation
Dates of Support: 1999–2011
Field of Work: Palliative and end-of-life care
Problem Synopsis: Advances in public health, preventive medicine, and medical technology have led to dramatic increases in the number of Americans living longer. While many people over age 65 enjoy good health for some time, eventually most adults will have one or more chronic illnesses often characterized by pain and frailty. The nation’s health care system is not well suited to address the array of medical, social, emotional, and other needs of patients living for long periods with serious, but not immediately terminal, conditions.
Synopsis of the Work: During 1999–2011, the Center to Advance Palliative Care (CAPC) at the Mount Sinai School of Medicine undertook a range of initiatives to increase the number of hospitals able to provide palliative care, make hospital-based palliative care standard practice, and develop standards for palliative care programs.
To achieve these goals, CAPC selected and supported nine Palliative Care Leadership Centers (six funded by RWJF) based at hospitals across the country, led a consortium of organizations in developing consensus standards of palliative care, and demonstrated cost savings attributable to palliative care. In addition, CAPC provided ongoing in-person and online resources, and training via national seminars, audio grand rounds, and guidebooks.
Key Results: CAPC developed a new understanding of palliative care that shaped the thinking of physicians, patients, and policy-makers. By distinguishing palliative care from end-of-life or hospice care, CAPC expanded its audience to include patients with serious, but not immediately life-threatening, conditions. Physicians and their patients could work simultaneously on providing care aimed at both curing the condition and ensuring that patients were comfortable and stable.
  • By 2009, the number of hospitals providing palliative care increased by 138 percent, from 658 to 1,568.
  • The Palliative Care Leadership Centers had trained 1,029 teams from hospitals across the country, 80 percent of which had established their own palliative care programs within two years.
  • In 2006, the National Quality Forum endorsed a framework for preferred practices in palliative and hospice care. In 2011, the Joint Commission launched a Palliative Care Advanced Certification program.
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