Friday, June 12, 2009

Two New RWJF-Funded Health Reform Reports Now Available

Five Steps to Health Care System Savings

The Center for American Progress released a new report that identifies five promising reform options that have the greatest potential for controlling health care costs:
  • increasing the amount Medicare pays for primary care;
  • paying for episodes of care instead of individual procedures;
  • encouraging Medicaid and private insurers to adopt Medicare’s payment methods;
  • reforming the tax treatment of employer-based health benefits; and
  • expanding research that identifies best practices in treating diseases effectively and affordably.

According to the report, the current system results in government programs that pay too little for primary care and too much for specialty care, which the authors say leads poor quality and higher costs. The report also states that the current way in which health benefits are taxed results in consumers using too much health care and suggests guidelines to curb the over-use of new, expensive procedures that may not yet be proven to be most effective.

What is ‘Post-Claims Underwriting’ and Why is Congress Paying Attention?

The little-known practice of “post-claims underwriting” is when an insurer investigates an individual or small group policyholder’s medical history after the policy has been issued—and after claims have been submitted. Insurers have said that post-claims underwriting prevents fraud and therefore helps keep premiums low. For individuals whose health coverage has been canceled after the onset of a serious medical condition, post-claims underwriting can have serious consequences for their health and financial well-being.

A primer developed by Peter Harbage and Hilary Haycock of Harbage Consulting—and funded by the Robert Wood Johnson Foundation—explores the practice, which is increasingly getting attention on Capitol Hill. The primer explores what is known and unknown about post-claims underwriting, and related state and federal regulations.

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