New Directions in Health Care

As the nation moves to provide high-quality care for more people at lower cost, the pressure is on to provide real value. A new Commonwealth Fund program on breakthrough opportunities in health care intends to zoom in on new and unconventional ways of delivering care.

About one-quarter of American workers are employed by companies with fewer than 50 people on the payroll, and until now, insurers have charged these employers more for health insurance. In this episode, The Commonwealth Fund's Sara Collins and grantee Jon Gabel explain how the Affordable Care Act has ended that practice, and given employers the ability to offer their workers a choice of affordable plans.

The 11 million undocumented immigrants in the United States are excluded from all provisions of the Affordable Care Act. Find out why improving access to care for these workers could benefit all Americans.

Today, Medicare pays health care providers based the number of services they provide, rather than the quality of that care. Sandy Hausman talks with Commonwealth Fund vice president Stuart Guterman and Michael Chernew of Harvard Medical School about how to reform Medicare payment in an effort to control health care spending growth while improving care.

The use of health care decision aids such as multimedia programs, videos, and even brochures can help patients become more engaged with their care, and lead to better health outcomes and lower health care costs.

A promising new program has reduced the number of hospitalizations among nursing home residents, sparing them unnecessary risk and saving significant amounts of money. Learn more about The Commonwealth Fund�supported INTERACT program, which helps nursing home staff identify problems early.

The new state-based health insurance exchanges, established under the Affordable Care Act, are where individuals, families, and small businesses will be able to buy affordable private health insurance starting in 2014. In this episode, Sandy Hausman interviews experts Sara Collins, Timothy Jost, and Sara Rosenbaum about how the exchanges will work and whom they will help.

"Accountable care is a shift in focus from payment for units of service to payment for taking good care of patients over time," explains The Dartmouth Institute's Elliott Fisher, M.D., in this episode about accountable care organizations, or ACOs. Through interviews with Dr. Fisher and Commonwealth Fund experts, Sandy Hausman explores how ACOs will change the way we think about care and how we pay for it.

This episode looks at a new scorecard on local health system performance from The Commonwealth Fund Commission on a High Performance Health System, and how communities can use its data to improve.

This podcast examines the implications of the Affordable Care Act for the nation's safety net health care providers, which include clinics and hospitals that serve low-income patients and those who have no insurance.

Sandy Hausman looks at a new study on state trends for employer-sponsored insurance premiums and deductibles that found a 50 percent increase in premiums between 2003 and 2010, and a 63 percent increase in the employee share of the premium for a family plan. Also discussed are Affordable Care Act provisions that should help lower premiums.

One of the biggest challenges in health care reform is how to care for people who qualify for both Medicare and Medicaid. This group tends to be sicker, poorer, and more costly than the average person in either program. This episode looks at reducing duplication of care and providing assisted living, among other strategies for helping "dual eligibles" and getting their health care costs under control.

The first of 70 million baby boomers turn 65 this year, and long-term services and supports (LTSS), which include home care, assisted living, and nursing home care, are on the rise. To help states identify gaps, AARP�s Public Policy Institute, The Commonwealth Fund, and The SCAN Foundation, developed the first state LTSS scorecard.

In the U.S., the complex process of seeking compensation for medical injuries makes it difficult for patients to receive compensation, and fear of lawsuits leads to defensive medicine. This episode looks at countries like New Zealand, which separate patient compensation and issues of medical malpractice.

Relatively little attention has been paid to the ways the health reform law seeks to strengthen the delivery system. This episode addresses how provisions to improve transparency, encourage more organized care, and promote payment reform affect those on the frontlines.