A new policy analysis funded by the National Institute for Health Care Reform examines the appeal of episode-based payments as an alternative to the current fee-for-service model. The method bundles payment for some or all services for a specific health condition or event over a certain period of time. Success depends upon defining what constitutes an episode of care; establishing episode-based payment rates and identifying providers to receive these payments; ensuring compatibility with other proposed payment reforms; and implementing pilot projects using a narrow set of health conditions, patients, and providers.

Presentation for the AcademyHealth Annual Research Meeting, Orlando, FL.

Presented for the AcademyHealth Annual Research Meeting, Orlando, FL.

Senior hospital executives responding to a 2005 national telephone survey report that Hospital Compare and other public reports on hospital quality measures have helped to focus hospital leadership attention on quality matters. This article notes that the executives also report increased investment in quality improvement projects and in people and systems to improve documentation of care. In addition, more consideration is given to best practices guidelines and internal sharing of quality measure results among hospital staff. Large, Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accredited hospitals appear to be responding to public reporting efforts more consistently than small, non-JCAHO accredited hospitals.

This article presents estimates of the proportion of the U.S. population that had mental health benefits in 1999, the extent of their coverage, and the proportion enrolled in health plans subject to the Mental Health Parity Act of 1996 (MHPA). Over three-quarters (76 percent) had mental health benefits as part of their health insurance. Approximately 18 percent had no such benefits; for the remaining 6 percent, mental health benefits could not be determined. Of the 18 percent with no mental health benefits, 84 percent also had no health insurance; the remainder (16 percent) had health insurance that did not cover mental health benefits. Estimates of the generosity of coverage indicate that for 44 percent of the population, benefits included prescription drugs as well as at least 30 inpatient days and 20 outpatient visits for psychiatric care. For 12 percent of the population, benefit generosity could not be determined. Finally, study results suggest that the MHPA affected only 42 percent of the U.S. population.

In April 2005, the Centers for Medicare & Medicaid Services and the Health Quality Alliance launched Hospital Compare, a web-based tool that helps acute care and critical access hospitals publish quality data for 17 clinical measures on heart attack, heart failure, and pneumonia. Approximately 4,200 hospitals across the country currently use Hospital Compare to disclose their scores for some or all of the 17 measures. On the basis of a nationally representative survey of senior hospital executives (typically the vice president of medical affairs or the chief medical officer) and directors of quality improvement departments, this report assesses how public reporting and Hospital Compare have affected hospitals. The assessment addresses experiences with public reporting; reactions of the media, payers, and purchasers to the data; changes in quality improvement efforts as a result of public reporting; and hospital leadership views on the federal role in future quality improvement programs, including pay for performance.

On May 25, the Centers for Medicare & Medicaid Services, the Delmarva Foundation for Medical Care, and Mathematica sponsored a one-day conference on the impact of hospitals’ publicly reported quality measures on hospitals themselves. Conference goals were to explore how hospitals achieve quality improvements, leverage public reporting, and coordinate multiple stakeholders in pursuit of the shared goal of quality improvement. This report summarizes key points made by the 13 speakers and addresses several themes that cut across the conference presentations.

The National Voluntary Hospital Reporting Initiative (NVHRI)—recently renamed the Hospital Quality Alliance: Improving Care Through Information—is a nationwide, collaborative effort to make the quality of hospital care more transparent to professionals and consumers. This report provides information on hospitals’ decisions to participate, their early experiences, and the initiative's influence on hospital quality improvement efforts. The authors conclude that the NVHRI has generated and maintained hospitals’ support because public reporting is viewed as “the right thing to do” and the NVRHI fits reasonably well with other quality initiatives in which hospitals participate. They also found signs that the NVHRI may, in concert with other initiatives, lead to better quality of care.

While there has been considerable attention to the issue of parity as a means of improving mental health coverage, little is known about the extent of current levels of coverage and the generosity of benefits. This report provides an overview of mental health insurance benefits for 1999. The researchers found that 76 percent of the U.S. population had mental health benefits as part of their health insurance, with state-to-state variations ranging from 69 to 80 percent; approximately 52 percent of those with health insurance had mental health benefits that met a benchmark standard of 30 inpatient days, 20 outpatient visits, and prescription drug coverage; and 37 percent of those with health insurance coverage had parity in mental health benefits.

Assesses the feasibility of estimating the impacts of the program, which helps disadvantaged middle school and high school students prepare for, apply to, get financial aid for, and begin attending college. Examines three evaluation options: 1) estimating impacts of the program as a whole in the entire U.S. using administrative data; 2) estimating impacts of the program as a whole within selected states using administrative data; 3) estimating impacts of specific program components using a random assignment demonstration and new data collected through surveys. The sponsoring agency, the U.S. Department of Education, deemed the second evaluation option as optimally feasible and cost-effective.

Examines options to develop and implement a national database for tracking participants in public assistance programs, with an eye toward tracking time limits across state boundaries and identifying those receiving benefits in two or more states at the same time.