The New Politics of US Health Care Prices: Institutional Reconfiguration and the Emergence of All-Payer Claims Databases

Prices are a significant driver of health care cost in the United States. Existing research on the politics of health system reform has emphasized the limited nature of policy entrepreneurs’ efforts at solving the problem of rising prices through direct regulation at the state level. Yet this literature fails to account for how change agents in the states gradually reconfigured the politics of prices, forging new, transparency-based policy instruments called all-payer claims databases (APCDs), which are designed to empower consumers, purchasers, and states to make informed market and policy choices. Drawing on pragmatist institutional theory, this article shows how APCDs emerged as the dominant model for reforming health care prices. While APCD advocates faced significant institutional barriers to policy change, we show how they reconfigured existing ideas, tactical repertoires, and legal-technical infrastructures to develop a politically and technologically robust reform. Our analysis has important implications for theories of how change agents overcome structural barriers to health reform

The Future of Public Health Informatics: Alternative Scenarios and Recommended Strategies

Background: In October 2013, the Public Health Informatics Institute (PHII) and Institute for Alternative Futures (IAF) convened a multidisciplinary group of experts to evaluate forces shaping public health informatics (PHI) in the United States, with the aim of identifying upcoming challenges and opportunities. The PHI workshop was funded by the Robert Wood Johnson Foundation as part of its larger strategic planning process for public health and primary care. Workshop Context: During the two-day workshop, nine experts from the public and private sectors analyzed and discussed the implications of four scenarios regarding the United States economy, health care system, information technology (IT) sector, and their potential impacts on public health in the next 10 years, by 2023. Workshop participants considered the potential role of the public health sector in addressing population health challenges in each scenario, and then identified specific informatics goals and strategies needed for the sector to succeed in this role. Recommendations and Conclusion: Participants developed recommendations for the public health informatics field and for public health overall in the coming decade. These included the need to rely more heavily on intersectoral collaborations across public and private sectors, to improve data infrastructure and workforce capacity at all levels of the public health enterprise, to expand the evidence base regarding effectiveness of informatics-based public health initiatives, and to communicate strategically with elected officials and other key stakeholders regarding the potential for informatics-based solutions to have an impact on population health

State Medicaid Policy Levers Related to Successful Health Information Exchange Among Providers

Background: In the U.S., patients seek health care across a variety of settings. Many providers must manage care without needed information about the patient’s history, past services or experiences. Health information exchange (HIE), the process of securely and appropriately sharing a patient’s medical data electronically, can enable coordinated, effective and efficient care by providing a fuller picture of the patient’s health. Despite legislative and regulatory efforts, meaningful sharing of clinical information for patient care remains elusive. States as payers of Medicaid may be poised to effect successful HIE. Purpose: To assess whether state Medicaid policy actions implemented in the context of the 2009 Health Information Technology for Economic and Clinical Health Act promoted HIE among health care providers.Methods: A coincidence analysis, a mathematical, cross-case approach, was conducted to assess which levers implemented by Medicaid agencies in 20 states could be considered difference makers for HIE among health care providers. States were categorized as having HIE based on the proportion of providers that reported exchanging data outside their systems. Results were reviewed with a Medicaid stakeholder panel to inform a plan for change. Results: State Medicaid agencies assessed in this study used a variety of policy levers in the areas of technical assistance, infrastructure investment and financial incentives and mandates. The coincidence analysis revealed two strategies that were consistently present among states that demonstrated data sharing. States that had HIE were those that assisted with electronic clinical quality measure submissions and used financial incentive programs to incentivize HIE, or invested in a statewide HIE organization and laboratory infrastructure but lacked financial incentive programs. Conclusion: Combining Medicaid policy levers in at least one of two ways made a difference for HIE. The success of specific forms of infrastructure investment was conditional on the use or absence of financial incentive programs, which suggests the burden of increased requirements on clinicians engaged in multiple quality improvement efforts may distract from HIE. State Medicaid stakeholders supported these conclusions and recommended actions such as aligning HIE efforts across programs and capitalizing on strategic priorities for Medicaid in order to address the complex issue of HIE.Doctor of Public Healt

Report of the LD 1818 Work Group to Evaluate Options and Actions Available to Improve the Availablity of and Access to Health Care Data and Examine the All-payor Claims Database System in Maine

https://digitalmaine.com/mhdo_docs/1000/thumbnail.jp

Challenges and opportunities in biodiversity conservation on private land : an institutional perspective from Central Europe and North America

Private land is gradually emerging as a global biodiversity conservation strategy for its potential to complement the existing protected area model in its attempt to halt the global biodiversity loss. However, involving private lands in conserving a public good face continuous challenges. While examining landowners’ motivations for conserving their land is imperative to its success, it is equally important to assess how other stakeholder groups perceive private land conservation. In order to capture the diversity and contrasts in implementing private land conservation, this research focuses on investigating the managerial perspectives on the status of private land conservation in two countries: USA and Poland. The paper presents the results of twenty five in-depth interviews that were conducted in the two countries. The US context, with a longer history and experience, captured complex interactions and factors that influence private land conservation, including role of conservation policies, civic sector organizations, stakeholder collaboration, technical and financial support, and nonmonetary motivations of landowners. The Polish context however, was limited to the regulatory model and as such did not differentiate private land conservation from traditional protected areas. Additionally, the lack of voluntary initiatives along with adequate policies and lack of awareness on private land conservation at a national and local level contributed to limited scope and understanding on the subject. The two case studies highlight the context dependency of such a strategy and bring to focus some of the factors that should be addressed while adopting conservation on private land as a biodiversity conservation strategy