U.S. Healthcare – Moving Forward

US Healthcare System Talk - ACA Importance

Last week I gave a presentation to the leaders of some women’s health advocacy organizations about where the U.S. healthcare system is heading, i.e., where we go from the current situation with the A.C.A. We had a great discussion, and the organizer of the event emailed me afterward to say, “Amazing is all I can say. You are the first person who could speak to [the] ACA in which people listened and engaged.”

Some of the key points I made included:

Focus on the future. Don’t relive the past.
Move forward from today’s strengths and weaknesses. The slide below describes health insurance coverage for 2015 showing dramatic increases in coverage in individual insurance and Medicaid, and a decrease in the uninsured.

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Health, Healthcare, and Government Spending (and a Culture of Health)

November 29, 2016 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Information & Communications, Innovation, Medicaid, Medicare, Politics, Private-Employer Based Health Insurance, Public Health, State-Level Healthcare Reform / 1 Comment

Why governments care about health spending and healthcare, how they are connected to overall government spending and priorities, and why addressing social determinants of health is so important for making lasting improvements, were the subjects I covered in a presentation at George Mason’s graduate policy school in September. My goal was to provide the soon-to-be policy analysts and advisers with a framework for understanding those issues so they will be able to provide useful recommendations to their future decision making bosses. (See the slide below for the topics covered in the presentation.) Links to videos of the talk are below, along with short descriptions – I think that Part 6 is particularly good.…

Challenges Estimating Future U.S. Healthcare Spending

June 23, 2016 / Michael D. Miller MD / Economics & Financing, Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Medicaid, Medicare, Politics / No Comments

The challenges of estimating future U.S. healthcare spending (and why projections are so often so inaccurate) is the focus of the third video segment from my guest lecture at George Mason University about Health and Budget Policy – see below. (The first two are in previous blog posts and are on the HealthPolCom YouTube Channel.)

The final two video segments on the topics of Medicaid, and the Changing U.S. Healthcare System will be posted next week. The five subjects covered in the video segments from the guest lecture are:

U.S. Spending on Health and Healthcare
Medicare and U.S. Healthcare Spending
Challenges for Estimating Future Healthcare Spending
Medicaid: Federal and State Fiscal Issues
Changing U.S.

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Medicare and U.S. Healthcare Spending

June 22, 2016 / Michael D. Miller MD / Access to Healthcare, Economics & Financing, Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Medicare, Politics / No Comments

The second video from my guest lecture at George Mason University about Medicare and U.S. Healthcare Spending in now available – see below. (The first was an overview of Health Spending in the United States, and is in the previous blog and also on the HealthPolCom YouTube Channel.)

The other video segments from my guest lecture that I’ll be posting over the next week or so will be on the following subjects:

Challenges for Estimating Future Healthcare Spending
Medicaid: Federal and State Fiscal Issues
Changing U.S. Healthcare System: New Payment and Delivery Models

Enjoy. pass along to your colleagues and friends.…

Medicare Trust Fund Solvency Projections (History Of)

July 29, 2014 / Michael D. Miller MD / Economics & Financing, Federal Healthcare Reform, Health System Reform, Medicare, Politics / 2 Comments

The 2014 Medicare Trustees’ Report was released yesterday. Amidst all the reporting was how the revised projections for the Medicare Trust Fund (for Part A) increased by 3 years from last year’s report. The Kaiser Family Foundation has a great summary of Medicare financing and projections for future spending, but below is another chart that shows the actual number of years of projected solvency for the Part A Trust Fund in the years since 1970 – in the years when the Trustees’ Report included such projections:

Two things to note about this chart: The dramatic leap up in 2010 mostly reflects a combination of the healthcare spending slowdown in the Great Recession and the legislative changes in the ACA that pared back Medicare payments.…

Health Reform and Transformation in San Diego & California

June 10, 2013 / Michael D. Miller MD / Delivery of Healthcare, Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Medicaid, Medicare, State-Level Healthcare Reform / 1 Comment

I recently sat down with Kevin Hirsch, MD, President of Scripps Coastal Medical Group* to talk about health reform and transformation in the San Diego region. (See video below.)

Dr. Hirsch’s insights are interesting and timely because California often precedes the rest of the country in adopting new approaches to healthcare delivery and financing problems. An example of this may be California’s 2006 Hospital Fair Pricing Act, which addressed very high hospital bills for the uninsured. This month’s Health Affairs includes an article that analyzes the impact of this law, and the authors’ findings contrast markedly with Steven Brill’s Time magazine article, “Bitter Pill: Why Medical Bills Are Killing Us.”…

Health Promotion, Prevention, Wellness, and Government Fiscal Policies

March 14, 2013 / Michael D. Miller MD / Delivery of Healthcare, Economics & Financing, Medicaid, Medicare, Politics, Private-Employer Based Health Insurance, Public Health / No Comments

I recently had the opportunity to give guest lectures at Georgetown University and the University of Virginia. At Georgetown I focused on employer’s perspectives on health promotion and disease prevention. (Videos of portions of that discussion are below.) At UVA’s Batten School of Public Policy I discussed fiscal issues and policies for government healthcare programs, e.g. Medicare and Medicaid. (A few slides from that discussion are below….. sorry no video.)

The opportunity to talk with our future clinicians, health system administrators, and policy makers was heartening and a bit terrifying. While the students are eager and passionate, I wonder about their historical understanding of our complex healthcare systems and the policies, programs, and initiatives that got us to where we are today.…

Health Spending: For What, To Whom, and Where It Is Heading

February 5, 2013 / Michael D. Miller MD / Economics & Financing, Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Medicaid, Medicare / 1 Comment

The data for 2011 US healthcare spending was reported in the January issue of Health Affairs. Below are some graphs showing how spending was distributed across the different categories of healthcare services in the years 2000, 2007, and 2011, as well as who paid for the spending. (My analyses and commentary follow these graphs. The source for all graphs is Health Affairs, 32, no. 1 (2013):87-99)

What Healthcare Spending Went For:

Where Healthcare Spending Funds Came From:Three highlights from the Health Affairs article are:

The distribution of healthcare spending for various services and providers has been relatively constant despite significant growth in total and per capita spending.

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Jimmy Buffett Medicare and Healthcare

January 30, 2013 / Michael D. Miller MD / Economics & Financing, Federal Healthcare Reform, Health System Reform, Innovation, Medicare, Private-Employer Based Health Insurance / No Comments

The title of Jimmy Buffett’s song “Changes in Latitudes, Changes in Attitudes” is a good description of the fundamental changes occurring in the US healthcare system: Within the Federal Government – and Medicare in particular – widespread “Changes in Latitudes, Changes in Attitudes” are evident in the implementation of the Affordable Care and HITECH Acts, and the overall leadership of the Department of Health and Human Services. Healthcare leaders in private organizations – and state and local governments – are embracing these changes, which collectively are leading to better healthcare quality and lower costs…. Or at least slower increases in healthcare costs, a.k.a.…

Why Healthcare Spending is Slowing – A New Normal?

June 1, 2012 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Economics & Financing, Federal Healthcare Reform, Health System Reform, Innovation, Medicare, Nutrition, Public Health / 3 Comments

The growth in healthcare spending has slowed in recent years. Many experts and pundits have sought to explain why – while also worrying, (or predicting), that this slowing is only temporary, i.e. past performance will predict the future.

Healthcare Delivery and Financing are Dynamically Evolving

The future will be significantly different than the past because our healthcare system, society, and economy are evolving into what might be called a “New Normal” state. Assuming current priorities and pressures continue, public and private sector organizations at all levels will increasingly emphasize value¹ in their decisions about spending and preferences for healthcare services – including choices about substituting one treatment option for another. …

Predicting the Future is Easy

May 23, 2012 / Michael D. Miller MD / Economics & Financing, Federal Healthcare Reform, Health System Reform, Medicare, Politics / No Comments

Predicting the future is easy. Predicting the future accurately, is hard.

Public policy deliberations about initiatives for improving healthcare delivery and financing are often handcuffed by an over-reliance on the accuracy of projections. This happens because estimates of costs, disease prevalence, utilization rates, etc. are embraced as descriptions of inevitable futures, rather than as well-executed analytical projections with inherent probability ranges. This metamorphosis from estimation to “factation” occurred though a predictable sequence:

Quantitative analyses yield estimates;
Estimates are published or presented;
Summaries of estimates are extracted from tables and slides;
These summaries – or “bottom lines” – are rhetorically converted by the media and others from “projections” and “estimates,” to what “will happen,” as in, “healthcare spending will be….”

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Era of Accountable Care

October 24, 2011 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Federal Healthcare Reform, Health System Reform, Medicaid, Medicare, Private-Employer Based Health Insurance / 1 Comment

For many months I’ve been talking about the array of health transformation initiatives the Department of Health and Human Services has been deploying as both demonstrations and programmatic changes. I’ve been characterizing this strategy to create more accountability as an evolving menu, buffet, or map – sort of like those magical Harry Potter maps where the lines keep appearing on the parchment to create a recognizable image.

As part of releasing the final rules for the Medicare Shared Savings Program, HHS also put forth a document subtitled “Menu of Options for Improving Care,” which is a list of some of the landmarks in the future map of an Era of Accountable Care.…

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