2018 was a year that defies easy categorization. In health policy, deep cynicism and hyperpartisanship often made evidence seem almost passé, a quaint paean to a time when research and data might contribute to thoughtful national debate. But if you listened closely, you also heard not-so-faint rumblings of a desire to get past slogans and bitter divides, to find areas of common ground, and to use evidence to improve health and health care, even if only incrementally.
The concept of a patient-centered medical home (PCMH) holds intuitive appeal, with its emphasis on coordination of care, improved patient-provider communication and patient engagement, use of health information technology, and expanded practice hours.
The evidence on the positive effects of Medicaid expansion on coverage, access, utilization, and financial security is substantial and growing.
On May 2 and 3, the School of Nursing sponsored a multidisciplinary “Think Tank” devoted to improving care for older adults with chronic illness. Led by Mary Naylor and Nancy Hodgson, it drew more than 40 external thought leaders, who joined Penn experts from across the University.
As the largest single source of health care spending, hospitals have drawn considerable attention from policymakers. Efforts to reduce costs have led to decreased lengths of hospital stays, but far less attention has been paid to where those patients go immediately after discharge. Medicare payment reforms implemented in the wake of the Affordable Care Act, such as hospital readmissions penalties and bundled payments, have made hospitals accountable for care beyond their walls, including institutional post-acute care.
The concern that value-based payments will worsen health disparities is not new. Much ink has been spilled about the best way to avoid penalizing hospitals that care for disproportionately poor populations, without rewarding poor performance. The big question has been whether and how to adjust value-based payments for socioeconomic factors.