Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Increasing Specialty Care Availability

Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Top TakeawaysThere are vast inequalities in access to and outcomes from specialty health care in the U.S. These inequalities are worst for minority patients, low-income patients, patients with limited English language proficiency, and patients in rural areas.A number of solutions have emerged to improve health outcomes for minority and medically underserved patients. These solutions fall into three main categories: increasing specialty care availability, ensuring high-quality care, and helping patients engage in care.As these inequities are also significant drivers of health costs, payers, health care provider organizations, and policy makers have a strong incentive to invest in solutions that will both improve outcomes and reduce unnecessary costs. These actors play a critical role in ensuring that equity is embedded into core care delivery at scale.Part 2: "Increasing Specialty Care Availability"Solutions such as telemedicine, innovative partnerships between specialists and primary care physicians, and centralized local referral networks improve access to specialty care

Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Call to Action for a System-wide Focus on Equity

Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Top TakeawaysThere are vast inequalities in access to and outcomes from specialty health care in the U.S. These inequalities are worst for minority patients, low-income patients, patients with limited English language proficiency, and patients in rural areas.A number of solutions have emerged to improve health outcomes for minority and medically underserved patients. These solutions fall into three main categories: increasing specialty care availability, ensuring high-quality care, and helping patients engage in care.As these inequities are also significant drivers of health costs, payers, health care provider organizations, and policy makers have a strong incentive to invest in solutions that will both improve outcomes and reduce unnecessary costs. These actors play a critical role in ensuring that equity is embedded into core care delivery at scale.Part 5: "Call to Action for a System-wide Focus on Equity"These solutions create value not only for patients, but also for health care providers and public and private payers.  Each of these actors have a role to play in scaling and sustaining the health equity solutions.

Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Striving for Equity in Specialty Care Full Report

Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Top TakeawaysThere are vast inequalities in access to and outcomes from specialty health care in the U.S. These inequalities are worst for minority patients, low-income patients, patients with limited English language proficiency, and patients in rural areas.A number of solutions have emerged to improve health outcomes for minority and medically underserved patients. These solutions fall into three main categories: increasing specialty care availability, ensuring high-quality care, and helping patients engage in care.As these inequities are also significant drivers of health costs, payers, health care provider organizations, and policy makers have a strong incentive to invest in solutions that will both improve outcomes and reduce unnecessary costs. These actors play a critical role in ensuring that equity is embedded into core care delivery at scale.

California: Round 1 - State-Level Field Network Study of the Implementation of the Affordable Care Act

This report is part of a series of 21 state and regional studies examining the rollout of the ACA. The national network -- with 36 states and 61 researchers -- is led by the Rockefeller Institute of Government, the public policy research arm of the State University of New York, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.In September 2010, six months after the passage of the Affordable Care Act, California became the first state in the nation to create its own insurance exchange, eventually named Covered California. This accelerated timeline was consistent with California's desire to be, in the words of the state's Health and Human Services Secretary and Exchange Board Chair Diana Dooley, the "lead car" in implementation of federal health care reform. Because of the speed with which it approached this task, as well as the sheer size of its coverage expansion, the decisions California has made have been influential both regionally and nationally. What has transpired in the state has had implications for other states as they addressed difficult issues, including minimizing adverse selection, promoting cost-conscious consumer choice, and seamlessly coordinating with public programs

The Impact of Technology Attitudes and Skills of Rural Health Clinic Nurses on the Level of Adoption of Electronic Health Records in Mississippi

The evolution of health information technology continues to reform the delivery of efficient, safe, and equitable healthcare in the United States. One such example is the emergence of electronic health records (EHRs) and the discerning emphasis placed on using this technology in meaningful ways. While the integration of EHRs into daily practice impacts all healthcare professionals, nurses remain a prominent driver in the successful adoption and usage of these systems. It is therefore imperative to understand the impact of nurses’ technology attitudes and skills on the level of EHR adoption in Mississippi. This quantitative study examined the technology attitudes and skills of rural health clinic nurses on the level of adoption and meaningful use (as defined by CMS) of electronic health records. Approximately 44 rural health clinic nurses (or those serving in a rural health clinic nursing capacity) participated in a survey that solicited demographic information, healthcare facility information, electronic health record information; and information regarding the technology skills, and technology attitudes of the respective participant. The findings show no significant relationships between current stage of EHR meaningful use and rural health clinic practice ownership; nor do factors that impede or facilitate the diffusion process significantly differ by practice ownership. Findings also indicate that the technology attitude of a nurse is not significantly impacted by (1) the age of the nurse, (2) the number of years of nursing experience, or (3) the current stage of EHR meaningful use at the nurses’ respective rural health clinic. Results of the study indicate that Mississippi’s rural health clinics are at varying levels of EHR meaningful use with some clinics still at a level of no adoption. In addition, technology attitudes of rural health clinic nurses still remain low. As evidenced by technology attitude scores, clinic nurses lack confidence in using technology and in the technology itself. Training should be focused on the application of health information technologies to increase nurses’ self-confidence and understanding of effective use. Further, administrators and practice owners should involve nurses throughout the adoption lifecycle to ensure nurses are a vital component in the development and integration of EHRs

Assessing the Financial Health of Medicaid Managed Care Plans and the Quality of Patient Care They Provide

Examines the administrative and medical expenses, quality of care, and financial stability of publicly traded health plans contracted to manage the care of Medicaid beneficiaries by plan characteristics and compared with non-publicly traded plans

Cleveland Hospital Systems Expand Despite Weak Economy

Tracks developments in metropolitan Cleveland's healthcare market during the recession, including capacity expansions at Cleveland Clinic and University Hospitals, shifting of costs from employers to employees, pressure on the safety net, and reform

Individual Insurance: Health Insurers Try to Tap Potential Market Growth

Examines the challenges the current individual health insurance market poses for insurers and consumers, the market's growth potential, market and regulatory conditions across states, and trends in marketing strategies. Considers policy implications

Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Helping Patients Engage in Specialty Care

Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Top TakeawaysThere are vast inequalities in access to and outcomes from specialty health care in the U.S. These inequalities are worst for minority patients, low-income patients, patients with limited English language proficiency, and patients in rural areas.A number of solutions have emerged to improve health outcomes for minority and medically underserved patients. These solutions fall into three main categories: increasing specialty care availability, ensuring high-quality care, and helping patients engage in care.As these inequities are also significant drivers of health costs, payers, health care provider organizations, and policy makers have a strong incentive to invest in solutions that will both improve outcomes and reduce unnecessary costs. These actors play a critical role in ensuring that equity is embedded into core care delivery at scale.Part 4: "Helping Patients Engage in Specialty Care"Specialty care actors are increasingly addressing the social determinants of health with community outreach, patient navigation, and patient support services

Competition Among Medicare's Private Health Plans: Does It Really Exist?

Competition among private Medicare Advantage (MA) plans is seen by some as leading to lower premiums and expanded benefits. But how much competition exists in MA markets? Using a standard measure of market competition, our analysis finds that 97 percent of markets in U.S. counties are highly concentrated and therefore lacking in significant MA plan competition. Competition is considerably lower in rural counties than in urban ones. Even among the 100 counties with the greatest numbers of Medicare beneficiaries, 81 percent do not have competitive MA markets. Market power is concentrated among three nationwide insurance organizations in nearly two-thirds of those 100 counties