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THE HELLER SCHOOL FOR SOCIAL POLICY AND MANAGEMENT

Brandeis University

Waltham, MA 02454

HS 5.13A ISSUES IN NATIONAL HEALTH POLICY

Fall 2014

Tuesdays 2:00-4:50 PM

Heller School, Altman Amphitheater G01

Stuart H. Altman, Ph.D.

Sol C. Chaikin Professor of National Health Policy

Stanley S. Wallack, Ph.D.

Professor and Executive Director – Schneider Institutes for Health Policy

THE HELLER SCHOOL FOR SOCIAL POLICY AND MANAGEMENT

Brandeis University, Waltham, MA 02454

HS 5.13A ISSUES IN NATIONAL HEALTH POLICY

Tuesdays 2:00 – 4:50 PM

Professor Stanley S. Wallack

Professor Stuart Altman

TA: Caroline Logan

Office hours by appointment, contact:

Wendy Colnon

Elizabeth Pinto

This course will survey and analyze the health care system in the United States, emphasizing the major issues and trends, which have made the subject of intense public concern. The course will cover the financing, delivery and payment of health care by both the public and private sectors. The U.S. national health reform, The Patient Protection and Affordable Care Act (PPACA), will be incorporated into the first lecture and weaved throughout the course. The last four meetings will discuss the new payment systems and the delivery models encouraged in PPACA. The course will discuss the reasons for the large number of Americans with no or inadequate health insurance and how PPACA will reduce the number significantly. The high level of health care costs, which is consuming an ever-larger proportion of our national income, will be analyzed. While we spend far higher percentage of our national income than any other country in the world, our quality of care is not the best and quality of care problems abound.

If you are a student with a documented disability on record at Brandeis University and wish to have reasonable accommodation for you in class, please see the Instructor immediately.

Course Requirements:

An analytic paper on a specific health policy issue addressed in the course is required. The paper should be a policy analysis paper rather than a review, research or survey paper; discussing a health care problem, the reasons for the problem and potential solutions. It should be kept short, about 12-to-15 pages (double-spaced). There will also be an in-class final exam.

PAPER DUE: December 2nd, 2014

FINAL EXAM: December 16th, 2014

Readings and LATTE:

Because the seminar concentrates on new and emerging issues, it is difficult to construct a reading list that is up-to-date and comprehensive yet challenging and realistic in scope. Scholarly articles, reports, policy briefs, book chapters, and other readings are assigned weekly. There are both required and recommended readings each week. Students are expected to read and synthesize required readings prior to class meetings. Readings are listed in the syllabus and are available to download/print via LATTE. Recommended readings are starred (*). Additional readings that address emerging national health policy issues may be added throughout the semester.

Required Readings

1.  Power, Politics, and Universal Health Care: The Inside Story of a Century Long Battle by Stuart H. Altman and David Shactman (Prometheus Books, September 2011) is recommended. Readings from Dr. Altman’s book appear in the syllabus with the abbreviation PPUHC. It is available in the print and electronic editions.

2.  The following books/reports are available on LATTE under “Introductory Material Reading”:

  1. Coverage Matters: Insurance and Health Care (2001), Institute of Medicine.

2.  Policy Options to Sustain Medicare for the Future, January 2013, Kaiser Family Foundation

(waiting for UPDATES)

3.  Medicaid A Primer 2013 http://www.kff.org/medicaid/upload/7334-04.pdf

(waiting for UPDATES)

  1. Employer Health Benefits: 2013 Summary of Findings, Kaiser Family Foundation and Health Research & Education Trust

A list of health policy resources that may be helpful to review throughout the semester is posted on LATTE. Lecture slides will also be available to download via LATTE.

For any students with little or no background on the U.S. health system, it is recommended that you read Understanding Health Policy, A Clinical Approach Sixth Edition (2012), Bodenheimer & Grumbach, Chapters 1-6 within the first two weeks of the class. It is available in print and electronic editions.

Updated 7/31/14

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Class 1 September 2

OVERVIEW of course: Paying for Healthcare in the U.S. – the medicare and medicaid programs and their future

  1. PPUHC, Chapters 4-8
  2. Policy Options to Sustain Medicare for the Future, Kaiser Family Foundation, January 2013
  3. Medicaid Primer, Kaiser Family Foundation, 2013
  4. Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA): http://www.kff.org/medicaid/upload/7863.pdf
  5. Medicare Prescription Drug Benefit Factsheet: http://www.kff.org/medicare/upload/7044-12.pdf

Class 2 September 9

THE NEED FOR HEALTH CARE REFORM, THE PASSAGE OF OBAMACARE (ACA) debate: single payer vs. obamacare vs. no reform

  1. PPUHC Prologue, Forward, Chap. 1-3, 11-18
  2. Kaiser Family Foundation, Summary of New Health Reform Law. http://www.kff.org/healthreform/upload/8061.pdf
  3. Analyzing the Impact of State Medicaid Expansion Decisions, The Kaiser Commission on Medicaid and the Uninsured, July 2013.
  4. Medicare Advantage Factsheet: http://www.kff.org/medicare/upload/2052-15.pdf
  5. A Critics View of the ACA: J. Antos, JC Capretta, “A health reform framework: Breaking out of the Medicaid model” AEI July 10, 2014.

Class 3, September 16:

Healthcare Payment Reform Included in ACA

  1. S. Wallack and C. Tompkins, “Realigning Incentives in Fee-For-Service Medicare, Health Affairs, 22(4), Jul/Aug 2003.
  2. E. Fisher, M. B. McClellan, J. Bertko et al. “Fostering Accountable Health Care: Moving Forward In Medicare” Health Affairs, Web Exclusive, January 2009, w219-w231.
  3. Berwick, DM. Launching Accountable Care Organizations: The proposed rule for the Medicare Shared Savings Program, NEJM 2011 Apr 21;364(16):e32.

4.  Frakt AB and Mayes R. “Beyond Capitation: How New Payment Experiments Seek To Find The ‘Sweet Spot’ In Amount of Risk Providers and Payers Bear” Health Affairs, September 2012;31(9):1951-1958.

5.  Sood N, Huckfeldt PJ, Escarce JJ, Grabowski DC, Newhouse JP. Medicare’s Bundled Payment Pilot For Acute And Post-Acute Care: Analysis And Recommendations On Where To Begin. Health Affairs. 2011;30(9):1708-17.

NO CLASSES SEPTEMBER 23—Brandeis Thursday schedule

Class 4, SEPTEMBER 30:

HISTORY OF PRIVATE HEALTH INSURANCE AND ITS CHANGING STRUCTURE: WHO ARE THE UNINSURED

  1. Kaiser Family Foundation and Health Research & Educational Trust, “Employer Health Benefits 2013” (Related resources available at http://ehbs.kff.org)
  2. Uwe E. Reinhardt, “Is Employer-Based Health Insurance Worth Saving?” NY Times, May 22, 2009.
  3. The Uninsured A Primer, Key Facts About Americans Without Health Insurance, October 2008, Kaiser Family Foundation (KFF).
  4. Coverage Matters, IOM
  5. James Robinson, The End of Managed Care” JAMA, 285 (20): 2622-2628, May 23/30, 2001

Class 5, October 7

DELIVERY SYSTEM reforms included in the aca

  1. K. Davis, Schoenbaum, S., Audet, A. “A 2020 Vision of Patient Centered Primary Care” Journal of General Internal Medicine, 2005, 20:953-957.
  2. Nutting, PA et al. Transforming Physician Practices to Patient-Centered Medical Homes: Lessons from the National Demonstration Project, Health Affairs, 30, no. 3 (2011):439-445.
  3. Friedberg, M.W et al. Association between Participation in a Multipayer Medical Home Intervention and Changes in Quality, Utilization and Costs of Care. JAMA 2014; 311(8): 815 – 825.
  4. MEDPAC Report, “Accountable Care Organizations” June 2009, pp. 39-56.
  5. Emanuel E. Why accountable care organizations are not 1990s managed care redux. JAMA (Chicago, Ill). 2012;307(21):2263-4:
  6. PPUHC Epilogue
  7. Auerbach, D.I., Liu, H., Hussey, P.S., Lau, C., and Mehrotra, A. Accountable Care Organization Formation is Associated with Integrated Systems But Not Higher Medical Spending. Health Affairs. 2013. 32(10): 1781 – 1788.

Class 6, OCTOBER 14

Growth in health costs, attempts to control it

  1. PPUHC Chapters 9 & 10
  2. Kaiser, Health Care Costs: A Primer (May 2012)
  3. Auerbach and Kellerman, “A Decade of Health Care Cost Growth Has Wiped Out Real Income Gains For An Average US Family”, Health Affairs September 2011 30: 1630-1636
  4. Roehrig and Rousseau, “The Growth In Cost Per Case Explains Far More of US Health Spending Increases Than Rising Disease Prevalence”, Health Affairs September 2011, 30:1657-1663
  5. Economic Concerns about integrated healthcare systems – Commonwealth of MA v. Partners Healthcare System, Inc., South Shore Health and Educational Corp. , and Hallmark Health Corp., Superior Court Civil Action No. 14-2033-BLS. July 21, 2014.

*White, C., J. D. Reschovsky, and A. M. Bond. 2014. “Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs.” Health Aff (Millwood).

TA SESSION Date/Time TBD (Optional)

Class 7, OCTOBER 21

TECHNOLOGICAL CHANGE, drug pricing AND COMPARATIVE EFFECTIVENESS

  1. J. Newhouse, “Medical Care Costs. How Much Welfare Loss?” Journal of Electronic Perspectives, 6(3), Summer 1992.
  2. D. Cutler, G. Long, E. Berndt, J. Royer, A. Fournier, A. Sasser, P. Cremieux, “The Value of Antihyperintensive Drugs: A Perspective on Medical Innovation” Health Affairs, 26(1), 97-110, January/February 2007.
  3. L. Baker, Acquisition of MRI Equipment by Doctors Drives Up Imagining Use and Spending. Health Affairs Dec 2010, Vol. 11, pp 2252-2254.
  4. Timbie JW, Schneider EC, Van Busum K, and Steven Fox D. “Five Reasons That Many Comparative Effectiveness Studies Fail To Change Patient Care And Clinical Practice” Health Affairs, October 2012 31(10);2168-2169.
  5. Megerlin F., Lopert R., Taymor K., Trouvin. J. Biosimilars and the European Experience: Implications for the United States. Health Affairs 2013. 32(10): 1803 – 1810.

Class 8, October 28

HOSPITAL PAYMENT Systems

  1. Stuart Altman, “The Lessons of Medicare’s Prospective Payment System Show That The Bundled Payment Program Faces Challengers” Health Affairs September 2012.
  2. Berenson, “The Growing Power of Providers To Win Steep Payment Increases From Insurers Suggest Policy Remedies May Be Needed”, Health Affairs, 2012 31:973-981.
  3. Medicare Payment Advisory Commission June 2013 Report: Chapters 2-4.
  4. Quentin, et al., “Hospital Payment Based on Diagnosis Related Groups Differs In Europe And Holds Lessons For The United States”, Health Affairs April 2013, 32:713-723.

Class 9, November 4

PHYSICIAN SUPPLY & PAYMENTS AND THE ROLE OF NON-PHYSICIAN PROFESSIONALS

  1. W. Hsaio et al, “Results and Policy Implications of the Resource-Based Relative-Value Study” NEJM, 1988, Vol. 319, No. 13.
  2. MEDPAC Report March 2009, Physician Payment, Spring pp. 77-105.
  3. R. A. Cooper, “Weighing the Evidence for Expanding Physician Supply,” Annals of Internal Medicine, 141;705-714, 2004. (www.annals.org)
  4. D.C. Goodman and E.S. Fisher. “Physician Workforce Crisis? Wrong Diagnosis, Wrong Prescription” New England Journal of Medicine, 358;16, www.NEJM.ORG, April 17, 2008.
  5. Grover, A. and Niecko-Najjum, L.M. Building a Health Care Workforce for the Future: More Physicians, Professional Reforms and Technological Advances. Health Affairs 2013. 32(11): 1922 – 1927.

Class 10, November 11

INTERNATIONAL COMPARISON IN HEALTHCARE Systems, UTILIZATION AND PRICES

  1. Health Care Systems In Transition: United Kingdom and Germany.
  2. R. Steinbrook. “Private Health Care in Canada” New England Journal of Medicine, 354;16 (April 2006) 1661-1664.
  3. J. Zwanziger and S. Brammli-Greenberg. “Strong Government Influence Over the Israeli Health Care System has led to low rates of spending growth” Health Affairs, 30, no.9 (2011):1779-1785.
  4. M. Stabile et al. Health Care Cost Containment Strategies Used In Four Other High Income Countries Hold Lessons for the United States: Health Affairs 2013 37:639-642
  5. Davies, K. Commonwealth Fund, “Mirror Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally”

Class 11, November 18

QUALITY OF CARE AND PERFORMANCE IMPROVEMENT programs

  1. M. Chassin, "Part 3: Improving the Quality of Care," New England Journal of Medicine, 335(14):1060-1063, Oct 3, 1996.
  2. Crossing the Quality Chasm: A New Health System for the 21st Century, Institute of Medicine, pp. 1-38, 2001. (See Latte). Also available at www.nap.edu/openbook/0309072808/html/1.html
  3. E. McGlynn, “The Quality of Health Care Delivered to Adults in the U.S., New England Journal of Medicine. 348(26):2635, Jun 26, 2003.
  4. Chassin, MR. Improving the Quality of Care: What’s Taking so Long? Health Affairs. 2013. 32(10): 1761 – 1765.
  5. Anderson, H., Rovik, K.A., and Ingebrigtsen, T. Lean Thinking in Hospitals: Is There a Cure for the Absence of Evidence? A Systematic Review of Reviews. BMJ Open. 2014; 4:e003873.

Class 12 november 25

emerging issues on health reform and health DIsparities

  1. E. Demko, “Providers, insurers grapple with narrow-network backlash” Modern Healthcare; July 21, 2014.
  2. T. Neuman and G. Jacobson, “Medicare Advantage: Take Another Look” Kaiser Family Foundation, May 7, 2014.

3.  Strategy & PWC, “Private health exchanges: Where are we headed? Developing an exchange strategy by employer segment, 2013.

  1. Agency for Healthcare Research and Quality, National Healthcare Disparities Report - 2011: Chapter 10, Priority Populations: http://www.ahrq.gov/qual/nhdr11/chap10.htm
  2. Kaiser Family Foundation, Reform and Communities of Color – Implications for Racial and Ethnic Health Disparities (September 2010) http://kff.org/disparities-policy/issue-brief/health-reform-and-communities-of-color-implications/
  3. Woolf S, Braveman P. Where health disparities begin: the role of social and economic determinants and why current policies may make matters worse. Health Affairs. 2011; 30(10): 1852 – 1859.
  4. Jha AK, Orav EJ, Epstein AM. Low-Quality, High-Cost Hospitals Mainly in South, Care for Sharply Higher Shares of Elderly Black, Hispanic and Medicaid Patients. Health Affairs. 2011; 30(10): 1904 – 1911.
  5. Trivedi AM, Grebla RC, Wright SM, and Washington DL. Despite Improved Quality of Care in the Veteran’s Affairs Health System, Racial Disparity Persists for Important Clinical Outcomes. Health Affairs. 2011; 30(4): 707-715.

TA SESSION Date/Time TBD (Optional)

Class 13 december 2

INTEGRATING Post-acute care with the ACUTE CARE/dual eligibles

  1. MedPac June 2013, Post-Acute Care, pp. 119-142.
  2. Chandra A, Dalton M, Holmes J. “Large Increases In Spending On Post-acute Care In Medicare Point To The Potential For Cost Savings In These Settings.” Health Affairs 2013 May;32(5):864-72
  3. Garfield RL, Zuvekas SH, Lave JR, Donohue JM. The Impact of National Health Care Reform on Adults With Severe Mental Disorders. Am J Psychiatry. 2011;168(5):486-94.
  4. June 2012. MedPac Report Chapter. Care Coordination programs for the dual-eligibles beneficiaries, pp 61 – 91 and June 2013 MedPac, Dual Eligibles 27 – 35.
  5. Kaiser Family Foundation Resources on Dual Eligible Beneficiaries

http://kff.org/tag/dual-eligible/

  1. Musumeci, M. “Explaining the State Integrated Care and Financial Alignment Demonstrations for Dual Eligible Beneficiaries” Kaiser Policy Brief, Kaiser Commission on Medicaid and the Uninsured, October 2012.

Class 14 December 9

State level activities: coverage & cost containment

1.  CMS Website: State Innovations Model Initiative: Model Design Awards Round One. Available: http://innovation.cms.gov/initiatives/State-Innovations-Model-Design/index.html.

2.  Reinhardt, U. The Many Different Prices Paid to Providers and the Flawed Theory of Cost Shifting: Is it Time for a More Rational All-Payer System? Health Affairs 2011. 30(11): 2125 – 2133.

TA SESSION Date/Time TBD (Optional)

Class 15 December 16

FINAL EXAM IN CLASS

Updated 7/31/14