Category Archives: Health care reform

Medicaid and mental health: A Tennessee approach

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Photo: Don via FlickrNashville cemetery statue

Last week we posted an update on mental health coverage under the Affordable Care Act, so let’s follow up with a look at what’s going on in Tennessee, courtesy of Holly Fletcher at The Tennessean.

Tennessee is among the 19 states that have not taken up Medicaid expansion under the ACA. This summer a Tennessee legislative task force put forth a proposal for a partial expansion program, with the first stage focusing in large part on people with mental illness or substance abuse disorders. If approved – which isn’t certain – it could later be expanded, but only if it meets cost and quality objectives. As Fletcher reported, that’s not so easy. Gov. Bill Haslam, a Republican, last year tried to enact a market-based version, only to be blocked by a more conservative legislature, as one commentator noted in the newspaper. Continue reading

Dental profession weighs in on the opioid abuse epidemic

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health, curating related material at healthjournalism.org. She welcomes questions and suggestions on oral health resources at mary@healthjournalism.org.

Photo: hjl via Flickr

In a “dear colleague” letter to dental professionals last month, American Dental Association President Carol Gomez Summerhays urged dentists to review their prescribing practices and more effectively counsel patients about the safe handling and use of medications, especially opioid painkillers.

Summerhays also urged dentists to consult databases maintained by state-run prescription drug monitoring programs that could help them identify “doctor-shopping patients” whose prescription histories may reveal drug-seeking behavior. Continue reading

Efforts proceed slowly to expand the mental health coverage gains made in ACA

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Photo: Jennifer Durban via Flickr

Congress recently passed a bill to combat opioid abuse (although it’s still fighting over funding it), and there’s a good chance lawmakers also will pass legislation updating a lot of the federal mental health programs in the fall – although lack of bipartisanship has reduced the scope of what could pass.

President Obama last month signed the opioid bill despite reservations about the lack of funding. Continue reading

Watch for potential pitfalls as CMS tests a new bundled payment program for cardiac care

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Photo: Penn State via Flickr

The Centers for Medicare & Medicaid Services just announced a five-year test, to begin next summer, of a new way to pay for the care of patients who have had a heart attack or need coronary artery bypass graft surgery.

As with any new payment model, unintended consequences are possible. The experimental bundled-payment program, which was announced July 25 and will begin July 1, 2017, potential could lead some physicians to sell their practices to hospitals, be financially risky and potentially harmful to the hospitals forced to participate, and could lead to an increase in heart attacks, warned Francois de Brantes, executive director of the consulting firm Health Care Incentives Improvement Institute and an expert on bundled payment models. Continue reading

Pros and cons of health payment reform: Capitation

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Photo: Yann via Flickr

Photo: Yann via Flickr

The Urban Institute and the Catalyst for Payment Reform have collaborated on a series of briefs about various forms of health payment reform. Over the summer we’ll look at some that are receiving a lot of attention from policymakers and payers.

Let’s start with capitation. The recent Centers for Medicare & Medicaid Services (CMS) announcement about Comprehensive Primary Care Plus (CPC+) isn’t a switch to a fully capitated system. But this five-year model, scheduled to launch in January, does offer a degree of capitation, and moves further toward shifting more payments to a per-patient fee. Let’s look at what Urban/Catalyst says about the benefits and drawbacks of a capitated primary care payment system. Continue reading