Electronic Information Standards to Support Obesity Prevention and Bridge Services Across Systems, 2010-2015.

Electronic information technology standards facilitate high-quality, uniform collection of data for improved delivery and measurement of health care services. Electronic information standards also aid information exchange between secure systems that link health care and public health for better coordination of patient care and better-informed population health improvement activities. We developed international data standards for healthy weight that provide common definitions for electronic information technology. The standards capture healthy weight data on the "ABCDs" of a visit to a health care provider that addresses initial obesity prevention and care: assessment, behaviors, continuity, identify resources, and set goals. The process of creating healthy weight standards consisted of identifying needs and priorities, developing and harmonizing standards, testing the exchange of data messages, and demonstrating use-cases. Healthy weight products include 2 message standards, 5 use-cases, 31 LOINC (Logical Observation Identifiers Names and Codes) question codes, 7 healthy weight value sets, 15 public-private engagements with health information technology implementers, and 2 technical guides. A logic model and action steps outline activities toward better data capture, interoperable systems, and information use. Sharing experiences and leveraging this work in the context of broader priorities can inform the development of electronic information standards for similar core conditions and guide strategic activities in electronic systems.

Partnership for a Healthier America: Creating Change Through Private Sector Partnerships.

PURPOSE OF REVIEW: This review provides background on the formation of the Partnership for a Healthier America (PHA), that was created in conjunction with the Let's Move! initiative, and an overview of its work to date. RECENT FINDINGS: To encourage industry to offer and promote healthier options, PHA partners with the private sector. Principles that guide PHA partnerships include ensuring that partnerships represent meaningful change, partners sign a legally binding contract and progress is monitored and publicly reported. Since 2010, PHA has established private sector partnerships in an effort to transform the marketplace to ensure that every child has the chance to grow up at a healthy weight. Many agreements between PHA and its industry partners align with the White House Task Force Report on Childhood Obesity. The reach and impact of over 200 partnerships attest to the success of this initiative.

Early experiences with accountable care in Medicaid: special challenges, big opportunities.

Accountable care organizations (ACOs) and the more general movement toward accountable care, in which payments are aligned directly with improvements in quality and cost, are intended to increase the incentives and support for higher value in health care. As of mid-2013, there are over 4 million beneficiaries covered by Medicare ACOs, and large private payers continue to enter new ACO arrangements with providers in all parts of the country. An increasing number of states have approved and are implementing accountable care models for their Medicaid programs. A review of some of these early state adopters demonstrates how the features of Medicaid populations, Medicaid providers, and Medicaid financing create some distinct issues for implementing ACOs in Medicaid. Many states that have relied on Medicaid managed care plans are moving to accountable care through these private plans. Some states also are implementing accountable care reforms through direct reforms in their payments to Medicaid providers, both through specific providers and regionally-based contracts. Others are implementing a mixture of private plan and public management approaches. States are moving toward more comprehensive accountable care payments through patient-centered medical homes, episode-based payments, and patient-level accountable care payment reforms; these payment reforms can be sequential and synergistic. Accountable care in Medicaid involves some distinct considerations such as performance measures, additional complications in shared savings related to the federal-state Medicaid funding structure, and potential antitrust issues in cases where states are pursuing reforms with implications for most or all providers in a geographic area. The evidence on the impact of the various early approaches to accountable care in Medicaid is just beginning to emerge, and it is likely that the best course for states will continue to depend on the distinctive institutional features of their Medicaid programs and health care delivery systems. As in other parts of the health care system, accountable care in Medicaid is likely to continue to expand and to evolve.

An evaluation of recent federal spending on comparative effectiveness research: priorities, gaps, and next steps.

The American Recovery and Reinvestment Act of 2009 included new funding for developing better evidence about health interventions, with a down payment of $1.1 billion for comparative effectiveness research. Our analysis of funds allocated in the legislation found that nearly 90 percent of the $1.1 billion will eventually be spent on two main types of activity: developing and synthesizing comparative effectiveness evidence, and improving the capacity to conduct comparative effectiveness research. Based on our analysis, priorities for the new funding should include greater emphasis on experimental research; evaluation of reforms at the health system level; identification of effects on subgroups of patients; inclusion of understudied groups of patients; and dissemination of results.

Reforming the Medicaid disproportionate-share hospital program.

Congress and the Obama administration are considering redirecting federal spending on the Medicaid disproportionate-share hospital (DSH) program to help pay for health reform. In this paper, we propose linking federal Medicaid DSH funding to state-level Medicaid enrollment or uninsured populations, or both. This approach could produce as much as $44 billion in federal savings over time without exposing hospitals to uncertain or across-the-board spending cuts. It could also gradually address state variations in Medicaid DSH funding. We also offer ideas to ensure that DSH spending is more directly connected than it is now to improvements in care for vulnerable populations.