Economic Competition

A. Health Care System Change as Viewed by

Information Needs Associated with the Changing Organization and Delivery of Health Care: Summary of Perceptions, Activities, Key Gaps, and Priorities. A. Health Care System Change as Viewed by Stakeholders

Important changes in the health care system are being tracked by the Center for Studying Health System Change, established and funded expressly for this purpose by the Robert Wood Johnson Foundation. Center staff recently summarized what they learned in interviews with top leaders in 15 national professional organizations and trade associations ab

II. PROJECT CONTEXT: HEALTH SYSTEM CHANGE AND

Information Needs Associated with the Changing Organization and Delivery of Health Care: Summary of Perceptions, Activities, Key Gaps, and Priorities. II. Project Context: Health System Change and Stakeholder Functions

KEY POINTS

Information Needs Associated with the Changing Organization and Delivery of Health Care: Summary of Perceptions, Activities, Key Gaps, and Priorities. A. Rationale For This Work

It could be argued that there is greater instability and change in our health care system today than at any other time in the recent past. The emphasis on market competition is strong among both private and public purchasers. Managed care has become the dominant arrangement both for delivering and for financing care for privately insured individua

Information Needs Associated with the Changing Organization and Delivery of Health Care: Summary of Perceptions, Activities, Key Gaps, and Priorities. Highlights and Key Findings

HHS’s interest in the information needs and associated data gaps created by the rapid transformation of the health system clearly strikes a responsive chord among diverse stakeholders. Our findings show that stakeholders perceive information on the “supply side” of the health system to be very important, with gaps in data serving as a major

Information Needs Associated with the Changing Organization and Delivery of Health Care: Summary of Perceptions, Activities, Key Gaps, and Priorities

This report summarizes the insights and conclusions drawn from a project to asses unmet needs for supply-side information on the health system. The project focused on identifying how information needs associated with a changing health care system are perceived by providers, insurers, purchasers, consumers, and government at various levels. The proj

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Building a More Responsive Federal Workforce: Lessons from the SC2 Pilot. 1. Introduction

In 2011, the U.S.

Building a More Responsive Federal Workforce: Lessons from the SC2 Pilot

In 2011, the U.S. federal government launched the Strong Cities, Strong Communities Initiative, a new model of federal-local collaboration designed to (i) improve how the federal government invests in cities, (ii) offer technical assistance to support local priorities, and (iii) help to coordinate funds at the local, state, and federal level. A co

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Performance Improvement 2011-2012. Has the Clinical Proteomics Technology for Cancer Program Been Implemented as Intended and What are Its Short-term Outcomes?

This study assessed the extent to which the Clinical Proteomic Technologies for Cancer (CPTC) program was implemented as intended and its short-term effects on the proteomic research community. The program was established to enhance technical abilities to identify and measure proteins accurately and increase reproducibility of proteomic biomarker

Performance Improvement 2011-2012

This report, Performance Improvement 2011-2012, the 17th in this series, summarizes the key findings from studies completed during the two fiscal-year period ending September 30, 2011.

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Performance Improvement 2008. What Was the Effect of Improved Financing for Medicare Advantage Plans on Plan Offerings?

Researchers examined whether funding affected availability of Medicare Advantage plans available locally and premiums and benefits under such plans. The Medicare Modernization Act (MMA) revised the monthly capitation rates, paying more to MA plans. HHS was required to report to Congress on the impact of additional financing provided under MMA and

Performance Improvement 2008. Goal 3 - Promote the Economic and Social Well-being of Individuals, Families, and Communities

P ROMOTE THE ECONOMIC AND SOCIAL WELL-BEING OF INDIVIDUALS, FAMILIES, AND COMMUNITIES This Strategic Goal seeks to protect life, family, and human dignity by promoting the economic and social well-being of individuals, families, and communities; enhancing the safety and well-being of children, youth, and other vulnerable populations; and str

Environmental Scan to Identify the Major Research Questions and Metrics for Monitoring the Effects of the Affordable Care Act on Safety Net Hospitals. References

AcademyHealth. “The Impact of the Affordable Care Act on the Safety Net.” Washington, DC: AcademyHealth, April 2011. Agency for Healthcare Research and Quality. “The Safety Net Monitoring Initiative: Fact Sheet.” August 2003. Available at [ http://archive.ahrq.gov/data/safetynet/netfact.pdf] . American Hospital Association. “TrendWat

F. Summary of Research Questions and Metrics

Environmental Scan to Identify the Major Research Questions and Metrics for Monitoring the Effects of the Affordable Care Act on Safety Net Hospitals. F. Summary of Research Questions and Metrics

Consistent with the above discussion, Table 1 summarizes the main research questions for monitoring the effects of the ACA on safety net hospitals, as well as the “ideal” set of measures that would be needed to answer these questions. For the environmental scan, we do not consider the feasibility of obtaining each of the measures or the potent

Environmental Scan to Identify the Major Research Questions and Metrics for Monitoring the Effects of the Affordable Care Act on Safety Net Hospitals. b. Maintaining Safety Net “Mission”

In the past decade, increased competition with other hospitals, rising demand from uninsured patients, and decreased revenue from payers resulted in a number of safety net hospitals adopting strategies that often mimicked non-safety net hospitals, including limiting their exposure to uncompensated care, managing payer mix, and expanding into more

Environmental Scan to Identify the Major Research Questions and Metrics for Monitoring the Effects of the Affordable Care Act on Safety Net Hospitals. a. Hospital Financial Performance

Because of their reliance on Medicaid revenue, the relatively large amount of care provided to uninsured patients, and decreasing revenue streams from federal, state, and local governments, most safety net hospitals operate with very low or negative margins. NAPH margins averaged 2.3 percent in 2010 compared to the 7.2 percent average margin natio

e. Safety Net Hospitals and Integrated Delivery

Environmental Scan to Identify the Major Research Questions and Metrics for Monitoring the Effects of the Affordable Care Act on Safety Net Hospitals. e. Safety Net Hospitals and Integrated Delivery Systems

Although it is too early to assess the effect of ACOs and other integrated delivery systems on safety net hospitals, such initiatives—if widely adopted—could have a profound impact on safety net hospitals by restructuring the delivery system to emphasize and incentivize primary care, care management, and care coordination with specialists. By

c. Collaboration and Experience with Medicaid

Environmental Scan to Identify the Major Research Questions and Metrics for Monitoring the Effects of the Affordable Care Act on Safety Net Hospitals. c. Collaboration and Experience with Medicaid Managed Care

The ACA also includes a number of provisions intended to accelerate the movement toward more integrated delivery systems and other reforms intended to improve efficiency, bend the cost curve, and improve quality of care for patients. These provisions are likely to have a profound impact, because historically the safety net has been fragmented in m

b. Competition for Newly Insured Patients

Environmental Scan to Identify the Major Research Questions and Metrics for Monitoring the Effects of the Affordable Care Act on Safety Net Hospitals. b. Competition for Newly Insured Patients

Prior research has shown that greater competition between hospitals in a community generally reduces financial margins as well as the amount of uncompensated care provided, including by safety net hospitals (Vogt and Town 2006). However, more recent research shows that the effects of competition on safety net hospitals specifically are more comple

7. Organization and Dynamics of the Local Health

Environmental Scan to Identify the Major Research Questions and Metrics for Monitoring the Effects of the Affordable Care Act on Safety Net Hospitals. 7. Organization and Dynamics of the Local Health Care System

How safety net hospitals are affected by and respond to health reform will depend in part on a number of factors related to the local delivery system. The most important of these local delivery system factors include system capacity, competition between providers, and payment and delivery system reforms.

Environmental Scan to Identify the Major Research Questions and Metrics for Monitoring the Effects of the Affordable Care Act on Safety Net Hospitals. D. Conceptual Framework

A conceptual framework for understanding the effects of health reform on safety net hospitals is shown in Figure 1. The framework draws on other efforts to develop a monitoring strategy for safety net hospitals, such as the Agency for Healthcare Research and Quality’s Safety Net Monitoring Initiative, as well as an initiative by HRSA to monitor

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