Vital Directions For Health And Health Care: Priorities For 2021.

In 2016, in anticipation of the US presidential election and forthcoming new administration, the National Academy of Medicine launched a strategic initiative to marshal expert guidance on pressing health and health care priorities. Published as Vital Directions for Health and Health Care, the products of the initiative provide trusted, nonpartisan, evidence-based analysis of critical issues in health, health care, and biomedical science. The current collection of articles published in Health Affairs builds on the initial Vital Directions series by addressing a set of issues that have a particularly compelling need for attention from the next administration: health costs and financing, early childhood and maternal health, mental health and addiction, better health and health care for older adults, and infectious disease threats. The articles also reflect the current experience with both the coronavirus disease 2019 (COVID-19) pandemic and the health inequities that have been drawn out sharply by COVID-19, as well as the implications going forward for action.

Correction to: Comparing Associations of State Reopening Strategies with COVID-19 Burden.

In the original version of this paper, an author was misidentified. The corrected author listing appears here, and has been updated in the online version.

Data Interoperability and Exchange to Support COVID-19 Containment

From the Executive Summary: The success of COVID-19 [coronavirus disease 2019] containment as the United States reopens will depend on timely sharing of key information related to testing, contact tracing, and detecting and acting on new outbreaks. Containment strategies across the country depend on effective collaboration of public health authorities with health care providers, laboratories, and community-based organizations to conduct testing, support effective contact tracing, quickly discern new patterns in health care use plausibly related to COVID-19, and identify ways to improve all of these activities over time. But public health, health care, and testing organizations have never had to work together with the scale or urgency required for COVID-19 containment. In particular, public health agencies are facing difficulties routinely accessing critical data from these other key participants in the containment effort, despite valiant attempts to cobble together information from many disparate systems.COVID-19 (Disease);Public health;Health--Testing;Public health surveillance

Health Care Payment to Support COVID-19 Detection and Containment

From the Executive Summary: CMS [Centers for Medicare & Medicaid Services] recently announced new COVID-19 [coronavirus disease payments to reimburse a broader range of state-authorized health professionals that order diagnostic tests, and to pay for specimen collection and test performance in community settings such as pharmacies. This report describes further payment supports for comprehensive and effective health care provider engagement in rapid case detection, management, and containment of the COVID-19 pandemic. Building on recent CMS actions, these payment reforms could be adopted individually or collectively to reinforce and support health care providers in developing the following capabilities to help contain COVID-19: [1] Provider capacity to conduct COVID-19 health monitoring and case detection for their population of patients;[2] Test sample collection or telemedicine supervision of tests done at home;[3] Test performance with rapid reporting, including timely data sharing with public health authorities;[4] Case management at home or in the community for infected individuals;[5] Assistance with contact tracing, quarantine, and follow-up management. These payments could be implemented in different ways, all of which either fall within current CMS authority for provider and laboratory test payment, or within the scope of COVID-19 legislation to assist health care providers.COVID-19 (Disease);Healthcare;Public health--Finance

Building the Critical Path for COVID-19 Therapeutics

From the Executive Summary: Hundreds of therapeutics are in preclinical or clinical development for treating COVID-19 [coronavirus disease 2019] patients. But as of May 2020, so far none have demonstrated effectiveness sufficient to warrant approval for general use, although one antiviral drug (remdesivir) has shown sufficient impact in ongoing clinical trials to support an authorization for emergency use. This is a reflection of the complexity, time, costs, and uncertainties associated with developing therapeutics - a process that not only encompasses preclinical evaluation and clinical trials to demonstrate safety and effectiveness, but also manufacturing at pandemic scale, and sufficient payment to enable appropriate and effective access. [...] Policy attention has understandably focused on the development of vaccines as the path to recovery. But even with these unprecedented actions, the widespread availability of effective vaccines remains many months away, if not longer. To reduce the impact of the pandemic in the meantime, intensive effort is also needed to accelerate therapeutics development to help prevent infections, reduce their severity, and mitigate or prevent further outbreak waves.COVID-19 (Disease);Therapeutics;Public health

The Past Decade of Paying for Value : From the Affordable Care Act to COVID-19.

The Affordable Care Act played a major role in transitioning American health care away from fee-for-service payment. We explore the spread of payment reforms since the implementation of the ACA, both nationally and in North Carolina; the corresponding effects on health care costs and quality; and further steps needed to achieve greater transformation.

Comparing Associations of State Reopening Strategies with COVID-19 Burden.

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) infected over 5 million United States (US) residents resulting in more than 180,000 deaths by August 2020. To mitigate transmission, most states ordered shelter-in-place orders in March and reopening strategies varied. OBJECTIVE: To estimate excess COVID-19 cases and deaths after reopening compared with trends prior to reopening for two groups of states: (1) states with an evidence-based reopening strategy, defined as reopening indoor dining after implementing a statewide mask mandate, and (2) states reopening indoor dining rooms before implementing a statewide mask mandate. DESIGN: Interrupted time series quasi-experimental study design applied to publicly available secondary data. PARTICIPANTS: Fifty United States and the District of Columbia. INTERVENTIONS: Reopening indoor dining rooms before or after implementing a statewide mask mandate. MAIN MEASURES: Outcomes included daily cumulative COVID-19 cases and deaths for each state. KEY RESULTS: On average, the number of excess cases per 100,000 residents in states reopening without masks is ten times the number in states reopening with masks after 8 weeks (643.1 cases; 95% confidence interval (CI) = 406.9, 879.2 and 62.9 cases; CI = 12.6, 113.1, respectively). Excess cases after 6 weeks could have been reduced by 90% from 576,371 to 63,062 and excess deaths reduced by 80% from 22,851 to 4858 had states implemented mask mandates prior to reopening. Over 50,000 excess deaths were prevented within 6 weeks in 13 states that implemented mask mandates prior to reopening. CONCLUSIONS: Additional mitigation measures such as mask use counteract the potential growth in COVID-19 cases and deaths due to reopening businesses. This study contributes to the growing evidence that mask usage is essential for mitigating community transmission of COVID-19. States should delay further reopening until mask mandates are fully implemented, and enforcement by local businesses will be critical for preventing potential future closures.