- N Engl J Med 2022; 387:385-388
In light of the shortcomings of the haphazard U.S. approach to public health, laid bare by the Covid pandemic, a Commonwealth Fund commission is proposing urgent, necessary, and realistic reforms.
- N Engl J Med 2022; 386:2352-2354
Michigan was among the first states to institute premiums for people covered by Medicaid expansion. Amid current uncertainty surrounding the use of premiums, the Michigan experience may provide insights into program design and the effects of premiums on coverage.
- N Engl J Med 2022; 386:1869-1871
More than 30 years after the Nursing Home Reform Act, the United States still fails to protect nursing home residents and provide them with high-quality care. The Covid-19 pandemic’s devastating effect on nursing homes reminds us that further reforms are sorely needed.
- N Engl J Med 2022; 386:1775-1777
Randomized, controlled trials remain underutilized within the Medicaid program, even though state Medicaid programs regularly implement new policies that require evaluation. What are the key barriers to implementing RCTs in Medicaid, and how can we increase their use?
- N Engl J Med 2022; 386:1773-1775
The Biden administration has made important incremental progress in expanding access to affordable health insurance. But its struggles to enact a broader reform agenda reflect the daunting political constraints that limit U.S. health policy.
- N Engl J Med 2021; 385:1057-1059
Facing daunting political, legal, and fiscal challenges, the public option health plans recently enacted by Washington State, Nevada, and Colorado have been narrowed to such an extent that they may fail to meet their affordability and coverage goals.
- N Engl J Med 2021; 385:1060-1062
Public Option 2.0 may be the most realistic way to guarantee universal coverage with a broad choice of providers and with medical prices held down by the government. If the United States is to achieve this elusive goal, however, advocates need to lay the groundwork now.
- N Engl J Med 2021; 385:673-675
In June, the U.S. Supreme Court rejected what will probably be the last major case seeking to uproot the ACA. The Court’s decision most likely marks an end to Republicans’ efforts to achieve in the courts what they have been unable to achieve in Congress.
- N Engl J Med 2021; 385:675-677
Models that hold organizations responsible for managing patients’ total cost of care are an important tool for payment reform. Bringing more clinicians into such models is essential, and strengthening current participation incentives could generate long-term benefits.
- N Engl J Med 2021; 385:387-389
Policymakers are moving forward with payment models that establish budgets for rural health care organizations. Such programs reflect an attempt to help remedy what ails rural health care: insufficient investment, high costs, and unstable and decreasing patient volume.
- N Engl J Med 2021; 384:788-791
Primary care plays a foundational role in a high-value health system, but the United States has seen troubling declines in practices’ financial viability. How best to pay for primary care, how much to pay, and how rapidly change needs to occur are urgent questions.
- N Engl J Med 2021; 384:759-764
The federal CMMI was created to assess new payment and service delivery models for improving health care nationwide. This review reports that during the agency’s first decade of operation, some of the value-based models saved money and improved quality but most did not. The lessons learned and future directions are...
- N Engl J Med 2020; 383:99-101
For patients with advanced kidney disease, especially hospitalized patients, dialysis may be presented as the opposite end of the treatment spectrum from comfort care. Collaborative efforts and amended policies could allow patients to have a better range of options.
- N Engl J Med 2020; 382:1581-1583
Adopting methods that account for all factors that influence patients’ risk, and those factors’ interdependence, could help create a more equitable health care payment system that better serves patients, including the most disadvantaged members of society.
- N Engl J Med 2020; 382:1057-1063
In this second of two Health Policy Reports marking the 10th anniversary of the Affordable Care Act, the authors describe major payment and delivery system reforms and analyze the available evidence about the effects of the ACA on the quality and costs of health care.
- N Engl J Med 2020; 382:963-969
The Affordable Care Act (ACA) was signed into law 10 years ago. This first of two Health Policy Reports reviewing the challenges and successes of the law focuses on the provisions of the law that expanded coverage. The ACA has reduced the number of Americans who are uninsured and the...
- N Engl J Med 2019; 381:2265-2269
To ensure that the patient–physician relationship remains central to medical practice, it is critical both to enable physicians to spend adequate time with patients who need extra time and to better coordinate care provided to individual patients by multiple specialists.
- N Engl J Med 2019; 381:898-901
Medicare’s new Primary Care First payment model ignores the low level of current Medicare payments for primary care, the need for greater investment, and lessons from the managed-care era about financial incentives tied predominantly to utilization reduction.
- N Engl J Med 2019; 381:4-6
Lawmakers could build on the HITECH Act by introducing additional criteria that prompt and guide health care providers in improving operational efficiency, requiring them to produce high-quality cost data and to integrate those data with data from their EHRs.