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2 posts from February 2014

02/20/2014

Primary Care Medical Homes, What Are They and Are They Working: A Conversation with Marci Nielsen (February 19th)

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The term "medical home" was first introduced in the 1960s by the pediatric profession.  Still to date this model of care emphasizes team-based comprehensive, continuous and coordinated care.   The care model is intended to improve primary care generally via improved patient communication, care quality, safety and outcomes.  In several ways the ACA encouraged the adoption of the, now termed, Primary Care Medical Home/PCMH for both the Medicaid and Medicare programs and among private health insurers.   (In some ways the PCMH is seen as a precursor for providers interested in becoming an Affordable Care Organization (ACO), i.e., taking on reimbursement risk.)  Over the past few years PCMHs have become widely adopted.  Over forty state Medicaid programs are experimenting with the model along with 90 commercial health plans and three federal initiatives. 

During this 23 minute discussion Dr. Nielsen discusses the PCPCC's purpose and goals, more specifically what is the PCMH model of care, the varying ways PCMH's are reimbursed, what does the research to date show regarding PCMH effectiveness and challenges in adopting this new model of care.

Dr. Marci Nielsen currently serves as CEO of the Patient Centered Primary Care Collaborative (PCPCC), an organization dedicated to advancing an effective and efficient health system built on a foundation of primary care.  Prior to the PCPCC, Dr. Nielsen served as Vice Chancellor for Public Marci%20Photo[1]Affairs and Associate Professor at the University of Kansas School of Medicine’s Department of Health Policy and Management.  Dr. Nielsen was appointed by then-Governor Kathleen Sebelius as first Executive Director and Board Chair of the Kansas Health Policy Authority (KHPA).  She worked as a Legislative Assistant to Senator Bob Kerrey and later served as the health lobbyist for the AFL-CIO.  Dr. Nielsen is a board member of the American Board of Family Medicine and also a committee member for the Institute of Medicine’s Leading Health Indicators for Healthy People 2020 and Living Well with Chronic Illness: A Call for Public Health Action.  Early in her career she served as a Peace Corps volunteer in Thailand and served for six years in the US Army Reserves.  Dr. Nielsen earned her MPH at The George Washington University and her Ph.D. from the Johns Hopkins School of Public Health.

The PCPCC's 1/14 PCMH impact on cost and quality report can be found at: http://www.pcpcc.org/newsletter/annual-report-pcmhs-impact-cost-quality-2012-2013.

02/06/2014

The Debate Over ACA-Mandated Contraceptive Coverage: A Conversation with Adam Sonfield (February 11th)

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In late January in a case involving a Catholic charity, the US Supreme Court issuesd a ruling temporarily exempting religious-affiliated non-profits from providing ACA-required contraceptive coverage.  (The ACA coverage requirement was based on an IOM recommendation that found birth control is "medically necessary."  The requirement took effect January 1st).  While churches and houses of worship are exempt, owned or controlled religious organizations can opt out of the contraceptive coverage requirement by completing and signing a form explaining their objection.  However, opponents say by opting out - that then allows the employee to obtain contraceptive coverage through a separate insurance policy - they are complicit in immoral conduct, i.e., they too should be exempted outright.  In addition, the Supreme Court has agreed to hear two cases that involve for-profit companies similarly objecting to the requirement.  

During this 20 minute conversation Mr. Sonfield discusses the specifics of the ACA contraception coverage requirement and why it was included as an "essential health benefit, exemptions to it including how religiously affiliated non-profits can avoid providing coverage and moreover, in light of the recent legal challenges to the contraception mandate, what the research shows regarding the benefits of women's contraception.              

Adam Sonfield joined the Guttmacher Institute in Washington DC in 1997.  (Guttmacher is a non-partisan reproductive health and rights research and policy shop.  Its goal is to "ensure the highest standard of sexual and reproductive health for all people worldwide.")  Adam currently serves as a Senior Public Policy Associate.  He is the managing editor and a regular contributor to the AdamSonfield[1]Institute’s public policy journal, the Guttmacher Policy Review.  Mr. Sonfield’s portfolio includes research and policy analysis on public and private financing of reproductive health care in the United States, the rights and responsibilities of health care providers and patients, and men’s sexual and reproductive health. He also writes a quarterly Washington Watch column for Contraceptive Technology Update.  Mr. Sonfield earned an A.B. with honors in social studies from Harvard and a Master of Public Policy, focusing in health policy, at Georgetown University.

The Guttmacher Institute's Supreme Court amicus brief can be found at: http://www.guttmacher.org/media/inthenews/2014/01/31/index.html,