New Directions in Health Care: Recent Episodes
The Commonwealth Fund
Annual Medicare spending is expected to double over the next 10 years, as baby boomers age and people live longer on average. And Medicaid will also see greater demand given that it provides coverage to more than 4.6 million low-income seniors. Experts are already concerned about funding these programs — and the tax law passed in late 2017, which is expected to add about $1.5 trillion to the federal deficit, poses new challenges. Federal responses to a ballooning deficit could put the health and financial security of future seniors at stake.
In this edition of our New Directions podcast, we look at why prices for prescription drugs are so high in the United States.
A new Commonwealth Fund podcast explores what repeal of the Affordable Care Act might mean for individuals and for the nation. Leighton Ku of the Center for Health Policy Research at George Washington University discusses his study, which found that 2.6 million jobs would be lost by 2019. And while the insurance industry waits for a possible repeal-and-replace the law, Sabrina Corlette of Georgetown University says uncertainty in the insurance market could lead to fewer plan choices and higher premiums.
India is home to Narayana Health, a chain of specialty care hospitals that delivers state-of-the-art medical services at a fraction of the cost charged here in the U.S. Sandy Hausman interviews Dr. Krishna Udayakumar of Duke University’s Global Health Institute, as well as Chandy Abraham, M.D., CEO of Health City, which offers high-tech, low-cost care in Grand Cayman.
MediCallHome is a subscription-based medical hotline that offers 24/7 to a doctor to resolve your minor medical issues. It's the model for a Spanish-language phone service for employers and consumers north of the border, too.
More than 60 percent of Brazil’s 200 million people are served by a model of primary care with community health workers at its center.
Basic Needs is a mental health program that is establishing self-help groups and changing public attitudes in Kenya and 12 other African and Asian nations. Producer Sandy Hausman interviews its founder as part of our new series on frugal innovations with global implications.
As the nation debates whether to replace or amend the Affordable Care Act, we’ll look at trends in health insurance provided by employers. Fifty-seven percent of adults under the age of 65 get coverage through their job—a benefit companies have kept since the passage of the ACA.
Prescription drug spending, a significant driver of overall health care costs, has been rising rapidly over the last few years. This episode explores the reasons for higher drug prices, including the introduction of new high-value medications, potentially inefficient research and development, and a lack of price regulation.
As more and more health insurers and providers merge, it’s important to look at the potential impact on the cost and quality of health care.
Greater use of medical technology and pharmaceutical drugs, as well as high prices, all contribute to high U.S. health spending, according to The Commonwealth Fund's latest cross-national spending brief. But Americans do not see better health outcomes relative to other wealthy nations as a result.
This episode offers an update on Medicaid—how the program has changed under the Affordable Care Act and what reforms we may see in the months and years to come. The Commonwealth Fund's Sara Collins discusses Medicaid enrollees’ satisfaction with their coverage and access to care, while George Washington University's Sara Rosenbaum examines how some states have taken different approaches to expanding eligibility for Medicaid. Transcript available.
A new podcast examines what the lack of insurance coverage has meant for racial and ethnic minority groups in this country and how the Affordable Care Act might change that. It also looks at resources designed to educate patients about their health and their coverage. Producer Sandy Hausman interviews Pamela Riley, M.D., assistant vice president for Delivery System Reform at The Commonwealth Fund, and Cara James, director of the Office of Minority Health at the Centers for Medicare and Medicaid Services.
The Affordable Care Act creates new opportunities to integrate behavioral health and primary care. This episode looks at the challenges and benefits of coordinating physical and mental health care through interviews with The University of Washington's Jurgen Unutzer, M.D., The Commonwealth Fund's Pamela Riley, M.D., and Deborah Bachrach, a partner with Manatt, Phelps and Phillips.
To improve decision-making at the health care provider level, policies that blend financial and non-financial incentives are being developed and tested. A new initiative called Incentives 2.0 is exploring this new type of payment reform. Hear from Anne-Marie Audet, M.D., and Mark Zezza, Ph.D., of the Commonwealth Fund and Kevin Volpp, M.D., Ph.D., of The University of Pennsylvania.
Learn how health IT can dramatically change health care delivery by improving communication and saving time—and can even save lives by providing key information at the right time.
Navigators are hired to help the public sign up for and choose a health insurance policy through online exchanges, or marketplaces, established by the Affordable Care Act. But some states have laws or regulations that are making it hard for navigators to perform this important role.
As the nation moves to provide high-quality care for more people at lower cost, the pressure is on to provide real value. A new Commonwealth Fund program on breakthrough opportunities in health care intends to zoom in on new and unconventional ways of delivering care.
About one-quarter of American workers are employed by companies with fewer than 50 people on the payroll, and until now, insurers have charged these employers more for health insurance. In this episode, The Commonwealth Fund's Sara Collins and grantee Jon Gabel explain how the Affordable Care Act has ended that practice, and given employers the ability to offer their workers a choice of affordable plans.
The 11 million undocumented immigrants in the United States are excluded from all provisions of the Affordable Care Act. Find out why improving access to care for these workers could benefit all Americans.
Today, Medicare pays health care providers based the number of services they provide, rather than the quality of that care. Sandy Hausman talks with Commonwealth Fund vice president Stuart Guterman and Michael Chernew of Harvard Medical School about how to reform Medicare payment in an effort to control health care spending growth while improving care.
The use of health care decision aids such as multimedia programs, videos, and even brochures can help patients become more engaged with their care, and lead to better health outcomes and lower health care costs.
A promising new program has reduced the number of hospitalizations among nursing home residents, sparing them unnecessary risk and saving significant amounts of money. Learn more about The Commonwealth Fund–supported INTERACT program, which helps nursing home staff identify problems early.
The new state-based health insurance exchanges, established under the Affordable Care Act, are where individuals, families, and small businesses will be able to buy affordable private health insurance starting in 2014. In this episode, Sandy Hausman interviews experts Sara Collins, Timothy Jost, and Sara Rosenbaum about how the exchanges will work and whom they will help.
"Accountable care is a shift in focus from payment for units of service to payment for taking good care of patients over time," explains The Dartmouth Institute's Elliott Fisher, M.D., in this episode about accountable care organizations, or ACOs. Through interviews with Dr. Fisher and Commonwealth Fund experts, Sandy Hausman explores how ACOs will change the way we think about care and how we pay for it.
This episode looks at a new scorecard on local health system performance from The Commonwealth Fund Commission on a High Performance Health System, and how communities can use its data to improve.
This podcast examines the implications of the Affordable Care Act for the nation's safety net health care providers, which include clinics and hospitals that serve low-income patients and those who have no insurance.
Sandy Hausman looks at a new study on state trends for employer-sponsored insurance premiums and deductibles that found a 50 percent increase in premiums between 2003 and 2010, and a 63 percent increase in the employee share of the premium for a family plan. Also discussed are Affordable Care Act provisions that should help lower premiums.
One of the biggest challenges in health care reform is how to care for people who qualify for both Medicare and Medicaid. This group tends to be sicker, poorer, and more costly than the average person in either program. This episode looks at reducing duplication of care and providing assisted living, among other strategies for helping "dual eligibles" and getting their health care costs under control.
The first of 70 million baby boomers turn 65 this year, and long-term services and supports (LTSS), which include home care, assisted living, and nursing home care, are on the rise. To help states identify gaps, AARP’s Public Policy Institute, The Commonwealth Fund, and The SCAN Foundation, developed the first state LTSS scorecard.
In the U.S., the complex process of seeking compensation for medical injuries makes it difficult for patients to receive compensation, and fear of lawsuits leads to defensive medicine. This episode looks at countries like New Zealand, which separate patient compensation and issues of medical malpractice.
Relatively little attention has been paid to the ways the health reform law seeks to strengthen the delivery system. This episode addresses how provisions to improve transparency, encourage more organized care, and promote payment reform affect those on the frontlines.
This episode focuses on a new report evaluating how well the nation cares for its kids. Producer Sandy Hausman explores why children's coverage has improved in 35 states despite the recession, what states can learn from each other, and how health reform can help.
Americans usually know what they can expect to pay for products—and most understand that you get what you pay for—but when it comes to health care, that's not the case. This episode looks at how sharing information about quality and costs with the public, payers, and health care professionals may change the way health care is delivered.
Sandy Hausman reports on the Safety Net Medical Home Initiative, a Commonwealth Fund-supported demonstration project designed to help clinics that serve low-income patients become medical homes.
Today, many primary care practices are sharing clinical and technical services with other providers so that they can become certified medical homes, which provide patients with coordinated, around-the-clock care. In Massachusetts, 95 percent of pediatric practices rely on the Child Psychiatry Access Project for guidance in mental health care.
Commonwealth Fund president Karen Davis discusses how the Affordable Care Act might improve U.S. health system performance relative to six other industrialized countries surveyed by The Commonwealth Fund.
This episode of the New Directions in Health Care series looks at the findings from a survey of federally qualified health centers. Community health centers are the core of the ambulatory care safety net—serving some 16 million Americans, regardless of their ability to pay.
This episode of the New Directions in Health Care series looks at the costs of providing medical services in other parts of the world and considers how health care reform might change the bottom line in this country. It explores ways in which proposed health reforms in Congress—such as an emphasis on primary care and new approaches to delivery and payment—could help ensure value for our health care dollars.
After Hurricane Katrina, New Orleans had "an unprecedented opportunity to redefine its health system." This episode looks at the network of safety-net clinics that was created following the disaster, and how many of these clinics have become medical homes that provide coordinated, accessible, and affordable primary care.
It's been three years since Massachusetts implemented sweeping health reform. In this episode, Sandy Hausman looks at how satisfied consumers, employers, and physicians are with the new system. Key players also discuss how a good public education campaign and a general spirit of cooperation contributed to the program's success.
Over the last 20 years, the quality of life and care in nursing homes has improved dramatically. But some experts say federal and state regulations of nursing homes can get in the way of these important changes, if caregivers and home operators see surveyors—who visit homes to make sure they are complying with standards—as the enemy. A new Commonwealth Fund report suggests that state inspectors could, in fact, be agents of change.
More than 13.2 million young adults in the U.S. have no health insurance coverage, finds a Commonwealth Fund study. While many young adults are healthy, this age group is in need of preventive care for the chronic conditions so many Americans develop. Learn how federal and state policies can help keep young people insured.
Given the tightly packed schedules of health care providers, there can be a lag time of as long as a decade in getting national recommendations into practice. Public-private improvement partnerships, a concept developed with Commonwealth Fund support by the Vermont Child Health Improvement Program, provide regional training, site visits, and more, to help with the process of change.
Being discharged from the hospital is something most patients eagerly anticipate, but many patients find themselves back in the hospital far too soon. A new Commonwealth Fund-supported initiative administered by the Institute for Healthcare Improvement called STAAR--State Action on Avoidable Rehospitalization--is a multi-state, multi-stakeholder collaborative that aims to reduce rehospitalization rates by 30 percent.
Women are disproportionately affected by health care costs, according to a new Commonwealth Fund study. The study authors say that medical debt--which affects women across all income levels--is forcing many women to skip care or make other sacrifices.
In this episode, producer Sandy Hausman visits a V.A. hospital in Virginia to see how electronic record keeping has improved quality on almost every measure of care. She also talks with the author of a Commonwealth Fund-supported study that provided crucial evidence linking health information technology, such as automated order entry, notes and decision-support, with lower mortality rates as well as lower costs.
Advancing Excellence in America's Nursing Homes is a group of long-term care providers, caregivers, consumers, and others that has engaged almost half of the nursing homes in the U.S. in its quality improvement efforts. For this episode, Emily Schifrin talked with the organization leadership and frontline workers to find out what has made the campaign so successful.
Residents, families, and staff say that Green Houses, based on a radically different model for long-term care created by geriatrician Bill Thomas, M.D., make warm, wonderful homes for elders. In this episode, Emily Schifrin visits two new Green Houses, in San Angelo, Texas, for elders with Alzheimer's disease.
Producer Sandy Hausman explains the role retail clinics, which operate in pharmacies, supermarkets and big-box retailers, play in providing basic health care to certain Americans who lack affordable alternatives.
In North Dakota, a trip to the doctor can involve "a lot of windshield time," explains Mary Wakefield, director of the Center for Rural Health at the University of North Dakota. In this episode, Sandy Hausman looks at how telemedicine--where health care is delivered by computer--is making it easier for people in rural areas to get the care and medication that they need.
The Assuring Better Child Health and Development initiative was designed to improve the delivery of developmental services though policy and practice change in selected states. In Iowa, a focus on screening, as well as on the mental health of the family and referrals to appropriate providers for treatment, has led to more comprehensive care.
Geisinger Health is a physician-led, integrated system that cares for about 2.5 million patients in Pennsylvania. Learn about the radical changes Geisinger has made to improve care for its patients while also improving efficiency.
A remodeled downtown location, same-day scheduling, and ready access to physicians have enhanced patient-centered care delivered by the Family Medicine Practice of The Polyclinic.
A new method of interpreting--where doctors and patients speak into enhanced telephones while an off-site interpreter translates--is helping improve patients' experiences and outcomes at Bellevue Hospital in New York City.
Hear how a culture change initiative at the Sarah Neuman Center in Mamaroneck, New York, and at Jewish Home Lifecare's Manhattan and Bronx campuses, is transforming life for residents and staff by deinstitutionalizing the physical environment, dining, the staffing structure, and more.
Because the U.S. health system is complex and fragmented, physicians find it difficult at times to put the needs of patients first. But some health care practices deliver patient-centered care despite the odds. In this episode, producer Sandy Hausman visits the Wheaton Franciscan Medical Group in Racine, Wisconsin, where staff are dedicated to exceptional patient service as well as superior clinical quality.