Commonwealth Fund releases framework for healthcare policy

A new set of strategies was released in a report by the Commonwealth Fund Commission on a high-performance health system to help improve how the U.S. healthcare system serves the uninsured, low-income or members of racial and ethnic minority groups.

The report, “Ensuring Equity: A Post-Reform Framework to Achieve High Performance Healthcare for Vulnerable Populations,” shows that closing the healthcare divide will require a three-pronged policy framework that ensures adequate access to healthcare and financial protection, strengthens the healthcare system's ability to serve vulnerable populations and supports coordination between the traditional healthcare system and the resources outside of the healthcare system that vulnerable groups rely upon.

The report highlighted the significant divide between vulnerable populations and their more secure counterparts in rates of receiving recommended screening and preventive care, control of chronic diseases and hospital admissions for conditions that may be preventable with good primary care and community health outreach. For example:

• Just four out of 10 low-income adults receive all recommended screening and preventive care, compared with six out of 10 higher-income adults.
• Twenty-nine percent of uninsured adults diagnosed with diabetes do not have it under control--twice the rate of the insured (15 percent).
• African American adults are hospitalized for heart failure at rates (959 per 100,000) more than twice the rate for Hispanic adults (466 per 100,000) and nearly three times the rate for white adults (349 per 100,000).

The authors noted that Patient Protection and Affordable Care Act (PPACA) provisions targeted at vulnerable populations will go a long way toward improving healthcare for these groups, primarily through expanded health insurance. Increased financial support for community health centers and reforms should improve healthcare quality and allow for people in vulnerable groups to receive better coordinated healthcare, the authors said. “However, vulnerable groups will remain at risk for poor health outcomes unless crucial issues beyond health insurance coverage like access to healthcare, affordability, care coordination and the financial stability of safety-net hospitals are addressed,” the authors added.

In the report, the 17-member commission outlined a policy framework that builds on PPACA reforms to create a more equitable healthcare system.

The overarching strategies revolve around ensuring adequate access and financial protection, strengthening the care delivery systems serving vulnerable populations and coordinating the traditional healthcare system with outside resources also affecting vulnerable groups, including:

• Creating enough willing providers for Medicaid beneficiaries: To alleviate the shortage of providers, and in particular specialty care providers willing to serve Medicaid patients, the Commission recommended considering payment reforms to reward high-quality networks of providers for providing optimal care for Medicaid beneficiaries, more equitable Medicaid payment rates, and developing the workforce needed to care for vulnerable populations.
• Stabilize health insurance coverage: This recommends limiting gaps and disruptions in health insurance that come from job or income changes by actions such as guaranteeing year-long coverage periods, providing access to the same insurance plans in exchanges and in Medicaid. The report also suggests merging small-group and individual health insurance exchanges, coordinating eligibility and enrollment for all subsidized insurance through exchanges, and ensuring that adequate numbers of community providers are included in both Medicaid and the subsidized plans.
• Limit out-of-pocket healthcare costs: The commission recommended protecting consumers—particularly low-income families who may struggle with out-of-pocket costs despite affordable premiums—from excessive out-of-pocket healthcare costs through insurance benefit programs with incentives to use effective care and reasonable income-related limits on overall out-of-pocket spending.