Contact the Engelberg Center
General Inquiries:
Email: healthreform @ brookings.edu
Fax: 202.238.3527
Press Inquiries:
Sara Tetreault, Communications Manager
Email: stetreault @ brookings.edu
Phone: 202.797.6114
Relevant Publications
Email: healthreform @ brookings.edu Fax: 202.238.3527 Sara Tetreault, Communications Manager Email: stetreault @ brookings.edu Phone: 202.797.6114
Bundled Payment Case Study Series
Engelberg Center for Health Care Reform, January 2012
Overview: These case studies look at three organizations, chosen by The Centers for Medicare & Medicaid Services (CMS), that want to provide services using bundled payment. CMS selected three sites, each one illustrative of a set of capabilities necessary for an organization to deliver cost-effective care in a setting where it bears financial risk for that care. The Engelberg Center for Health Care Reform at the Brookings Institution worked with MITRE to generate the case studies, conducting interviews with organizational leaders and affiliate experts from the case study sites.
Implementing Bundled Payment: A Case Study of Crozer-Keystone Health System
Improvements in Care-Transitions: A Case Study of St. Luke’s Hospital
Moving toward Bundled Payments: Physician Leadership as a Core Competency: A Case Study of Aurora Health Care
Issue Brief: Aligning Public and Private Sector Timelines for Health Insurance Exchange Implementation »
Engelberg Center for Health Care Reform, December 2011
Overview: Beginning in 2014, as mandated by the ACA, individuals will be able to purchase insurance coverage through health insurance exchanges (“Exchanges”) in the individual and small-group markets. If implemented effectively, these Exchanges provide the potential to increase health care value by promoting managed competition between health plans based on quality and cost. This issue brief covers barriers and challenges to implementing these Exchanges.
Discussion Paper: Promoting High Quality and Value through Health Insurance Exchanges»
Engelberg Center for Health Care Reform, August 2011
Overview: In early July 2011, the Department of Health and Human Services published a Notice of Proposed Rule-Making (NPRM) to provide detailed requirements for the implementation of Exchanges. However, guidance on how Exchanges should measure and report on health care quality is only addressed very broadly in the NPRM. This paper summarizes a panel discussion, convened by the Engelberg Center, on how Exchanges can improve health care quality and value through better measurement, purchasing strategies, and providing consumers with compelling quality information to enable more informed health care decisions.
An Accelerated Pathway for Targeted Cancer Therapies »
Nature Reviews Drug Discovery, February 2011
Overview: In a recent article, Mark McClellan, Josh Benner and other experts discuss how a well-defined pathway for the accelerated development and approval of targeted cancer therapies and companion diagnostics would reduce uncertainty, improve efficiency in development and provide an effective incentive for developers.
Developing the Sentinel System – A National Resource for Evidence Development »
New England Journal of Medicine, January 2011
Overview: The U.S. Food and Drug Administration (FDA) now has the ability to "query" the electronic health information of more than 60 million people, posing specific questions in order to monitor the safety of approved medical products. This pilot program, called Mini-Sentinel, uses a distributed data network (rather than a centralized database) that allows participating health plans and other organizations to create data files in a standard format and to maintain possession of those files.
Achieving Better Chronic Care at Lower Costs Across the Health Care Continuum for Older Americans »
Engelberg Center for Health Care Reform, October 2010
Overview: In a new paper, the Engelberg Center addresses many of the challenges facing individuals with chronic conditions and functional impairments and identifies new opportunities for the integration of medical services and social supports tailored to older Americans and supported by new payment designs.
Bending the Curve Through Health Reform Implementation »
Engelberg Center for Health Care Reform, October 2010
Overview: In September 2009, a group of leading health policy experts, including Engelberg Center Director Mark McClellan, released a set of concrete, feasible steps for both slowing spending growth and improving quality and value in health care. In light of the Patient Protection and Affordable Care Act, these experts have regrouped to update their recommendations.
An Evaluation of Recent Federal Spending on Comparative Effectiveness Research »
Health Affairs, October 2010
Overview: 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. An analysis of funds allocated in the legislation concluded that priorities for future 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.
Beyond the Affordable Care Act: Achieving Real Improvements in Americans' Health »
Health Affairs, August 2010
Overview: Improved access to health care is essential if we are to fill the striking gaps between how healthy Americans are and how healthy they could be, but access alone is not enough. Health and longevity are also profoundly influenced by where and how Americans live, learn, work, and play.
Insurance Exchanges Under Health Reform: Six Design Issues for the States »
Health Affairs, June 2010
Overview: The Patient Protection and Affordable Care Act depends on new, state-based exchanges to make health insurance readily available to certain segments of the population. One such segment is the lower-income uninsured, who can qualify for subsidized coverage only through an exchange. Visiting Scholar John Bertko outlines important design issues that states must face in structuring these new exchanges.
Using Health Information Technology to Support Better Health Care: One Infrastructure with Many Uses »
Engelberg Center for Health Care Reform, May 2010
Overview: This background paper briefly summarizes how health IT can be used to improve population health and provides examples of efforts being undertaken today to make enhanced uses of health information. It concludes with a discussion of the urgent need – and opportunities – to facilitate the enhanced use of health information on a much wider scale, particularly in light of ARRA and recently enacted health reform legislation.
A National Strategy to Put Accountable Care into Practice »
Health Affairs, May 2010
Overview: The concept of accountable care organizations (ACOs) has been set forth in recently enacted national health reform legislation as a strategy to address current shortcomings in the U.S. health care system. Mark McClellan and other experts review issues related to ACOs, looking at key principles, ACOs in context of other reforms, and emerging issues that will affect success. The authors also propose a national strategy for successful ACO implementation.
Health Care Reform and Older Americans: Achieving Better Chronic Care at Lower Costs »
Engelberg Center for Health Care Reform, January 2010
Overview: Policy debates have focused on steps to improve care and lower costs in acute-care settings, such as hospitals. However, to be successful, these payment reforms should include long-term services and supports, which can make a big difference in helping individuals with multiple chronic diseases that face many preventable complications and duplicative or poorly coordinated services.
Reforming the Medicaid Disproportionate Share Hospital Program »
Engelberg Center for Health Care Reform, January 2010
Overview: Building on their recent Health Affairs paper, Aaron McKethan, Larry Kocot, and other experts examine different policy approaches to reduce Medicaid Disproportionate Share Hospital (DSH) Program spending while proposing new ideas that could help ensure such spending is more directly connected to the delivery of care for vulnerable populations.
Bending the Curve: A Comparative Review
of the Senate Finance Committee Reform Proposal »
Engelberg Center for Health Care Reform, September 29, 2009
Overview: In early September, the Engelberg Center for Health Care Reform released a report, Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth, to help inform the current debate. A new brief provides a high-level review of the legislation introduced by Senate Finance Commitee Chairman Max Baucus, including a side-by-side summary of key provisions of the Bending the Curve report and those in the Baucus proposal.
Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth »
Engelberg Center for Health Care Reform, September 1, 2009
Overview: With the President, members of Congress, and key stakeholders seeking aggressive reforms to slow spending growth while improving value, a group of 10 health care policy experts has released Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth, a report outlining potential reforms to achieve such a goal.
Improving Quality and Value in the U.S. Health Care System »
Bipartisan Policy Center, August 21, 2009
Overview: The U.S. health care system faces significant challenges that clearly indicate the urgent need for reform. Attention has rightly focused on the approximately 46 million Americans who are uninsured, and on the many insured Americans who face rapid increases in premiums and out-of-pocket costs. As Congress and the Obama administration consider ways to invest new funds to reduce the number of Americans without insurance coverage, we must simultaneously address shortfalls in the quality and efficiency of care that lead to higher costs and to poor health outcomes.
Reforming the Medicaid Disproportionate-Share Hospital Program »
Health Affairs, August 18, 2009
Abstract: Congress and the Administration are considering redirecting federal spending on the Medicaid disproportionate-share (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.
Evolving State Approaches to Expand Coverage in the Current Wave of State Access Reform »
State Coverage Initiatives, Robert Wood Johnson Foundation, July 24, 2009
Overview: In the latest wave of state access reform, states are undertaking a range of initiatives to improve the availability and affordability of health insurance in the small and non-group markets. Some of the approaches implemented today — including health insurance purchasing exchanges and limited-benefit plans — are variations on approaches attempted by states in earlier waves of health reform. While these past efforts were helpful to individuals who enrolled, they generally did not result in broad-based coverage expansions.
Crossing Our Lines: Working Together to Reform the U.S. Health Care System »
Bipartisan Policy Center, June 17, 2009
Overview: This bipartisan framework, released by former U.S. Senate Majority Leaders and Bipartisan Policy Center's (BPC) Advisory Board members Howard Baker, Tom Daschle and Bob Dole, provides recommendations for comprehensive health reform to ensure every American has affordable, quality health coverage. The report is a product of the BPC's Leaders' Project on the State of American Health Care, which was launched last year and is co-directed by health care policy experts Chris Jennings and Mark McClellan.
Implementing Comparative Effectiveness Research: Priorities, Methods, and Impact »
Engelberg Center for Health Care Reform, June 2009
Overview: These comparative effectiveness research (CER) discussion papers, released at a forum hosted by the Engelberg Center for Health Care Reform and The Hamilton Project, focus on how research questions should be prioritized, what methods and data infrastructure are needed for CER, and how CER findings can be used to improve clinical and health policy decisions.
Fostering Accountable Health Care: Moving Foward in Medicare »
Health Affairs, January 27, 2009
Abstract: To succeed, health care reform must slow spending growth while improving quality. We propose a new approach to help achieve more integrated and efficient care by fostering local organizational accountability for quality and costs through performance measurement and "shared savings" payment reform. The approach is practical and feasible: it is voluntary for providers, builds on current referral patterns, requires no change in benefits or lock-in for beneficiaries, and offers the possibility of sustained provider incomes even as total costs are constrained. We simulate the potential expenditure impact and show that significant Medicare savings are possible.
Priorities for Reform »
Engelberg Center for Health Care Reform, November 17, 2008
Overview: There is now growing consensus that integrating efforts to improve access to affordable coverage with steps to promote real reforms in the delivery of health care will, in turn, improve the sustainability of both affordable coverage and medical innovation. The Engelberg Center has outlined several priorities for getting to real health care reform.
Real Health Care Reform in 2009: Getting to Better Quality. Higher Value, and Sustainable Coverage »
Engelberg Center for Health Care Reform, November 2008
Overview: From the standpoint of presidential and congressional leadership heading into 2009, one thing is clear: Now is the time for action on a different vision for health care reform. By bringing a focus on changing how health care works to next year’s health care reform strategy, the new president and Congress may be able to craft a bipartisan path forward that makes real progress on the nation’s core health care challenges. Doing so will require leadership not only in developing policy ideas that can save money and improve care, but also in redefining the problem and in building bipartisan support for taking action to address it.
Strengthening State/National Partnerships to Support Delivery System Reform »
Engelberg Center for Health Care Reform, October 2008
Overview: Across the country, the consistency with which high-quality, evidence-based health care is provided is remarkably uneven. The challenge of care coordination in an increasingly complex and fragmented delivery system is widely acknowledged. And rising health care costs and other state and federal fiscal challenges threaten not only the feasibility of greatly reducing the number of people without insurance, but also the affordability of health insurance for those who already have coverage. Given these challenges, public and private stakeholders at the state and national level have a strong, shared interest in improving the delivery of health care in order to improve quality and lower overall cost growth.