Health Literacy Practices in Primary Care Settings: Examples from the Field

January 31, 2008

Sharon E. Barrett, Jennifer Sheen Puryear, and Kathie Westpheling. Health Literacy Practices in Primary Care Settings: Examples from the Field. New York: Commonwealth Fund, January 2008.
Low health literacy is widespread among U.S. patients, yet limited research has been done to assess the effects of health literacy practices designed to combat the problem, particularly among safety-net providers in primary care settings. This report presents findings from a 2005 study in which the Association of Clinicians for the Underserved first did an online survey of health care facilities across the country and then followed it up with visits to five selected sites for staff and patient interviews. The study identified five health literacy practices that staff considered especially valuable for their group’s patients and potentially applicable to other clinics: a team effort, beginning at the front desk; use of standardized communication tools; use of plain language, face-to-face communication, pictorials, and educational materials; clinicians partner with patients to achieve goals; and organizational commitment to create an environment where health literacy is not assumed. Full report (pdf)

Paying for quality: Understanding and assessing physician pay-for-performance initiatives

January 31, 2008

Jon B. Christianson, Sheila Leatherman, and Kim Sutherland. Paying for quality: Understanding and assessing physician pay-for-performance initiatives. Princeton, N.J. Robert Wood Johnson Foundation, Research Synthesis Report No. 13, December 2007.

To date, policy-makers have had little information on the effectiveness of P4P initiatives in shifting physician practice. They are interested in knowing to what extent and under what circumstances P4P will improve the quality of care delivered by physicians. This synthesis report reviews the available evidence on this issue, addressing five questions: 1. What explains the current widespread interest in physician P4P? 2. How are current incentive programs structured and how prevalent are they? 3. What performance measurement issues does physician P4P raise? 4. How do physicians perceive quality incentive programs? 5. What is the research evidence on the impact of P4P? Full report (pdf)

Listening to Consumers: Values-Focused Health Benefits and Education

January 31, 2008

Listening to Consumers: Values-Focused Health Benefits and Education
By Lois A. Vitt, Institute for Socio-Financial Studies (ISFS), and Ray Werntz, EBRI Fellow. EBRI Issue Brief No. 313. January 2008.

This report on how employers can provide useful information to employees in conjunction with consumer-directed health plans concludes: “Consumer values can provide essential insights into consumer thinking about health-related behaviors and financial decision-making. They also can provide a blueprint for health care businesses and policymakers working to make the U.S. health care system more responsive to consumers. Should health education initiatives prove ineffective, the “consumer-driven health movement” could well be doomed, especially if it relies upon fully educated health consumers taking self-initiated actions. The perceived ineffectiveness of education in 401(k) plans resulted in legislation to add “defaults” to these plans so that they no longer relied upon positive employee action. In the health arena, the default approach is exactly what the consumer-driven
health model seeks to move away from.”  Full report (pdf)

The Health Care System for Veterans: An Interim Report

January 31, 2008

Congressional Budget Office. The Health Care System for Veterans: An Interim Report. Washington, DC: CBO, December 2007.

This interim report provides a brief overview of VA’s medical system, summarizes some of the recent evidence on the quality of VA’s medical care and describes the incentives for quality that VA has included in its performance management system. The report also examines ways in which the department’s health IT may affect the quality of care. CBO’s final report, anticipated in early 2008, will address the potential for other government and private health care providers to make use of VA’s experience, along with other issues.

State Efforts to Reduce Number of Uninsured being Compromised

January 31, 2008

New reports released today by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) describe aggressive efforts by states in the past year and a half to expand coverage to low-income children and their families, but the actions may be curtailed as a deteriorating economic climate and new limits on federal assistance take effect.  A downturn in the economy, the federal failure to reauthorize the State Children’s Health Insurance Program (SCHIP) and new federal rules affecting Medicaid and SCHIP eligibility all suggest that the recent period of aggressive expansion of coverage by states may be over. This is the conclusion based on a series of new studies by the KCMU, including a 50-state survey of eligibility and enrollment rules in Medicaid and SCHIP for children and families, interviews with Medicaid directors in ten states representing all regions of the country, and recent studies of enrollment in Medicaid and SCHIP.The reports released today include: * Health Coverage for Children and Families in Medicaid and SCHIP: State Efforts Face New Hurdles,
* Current Issues in Medicaid: A Mid – FY 2008 Update Based on a Discussion with Medicaid Directors,
* SCHIP Enrollment in June 2007: An Update on Current Enrollment and SCHIP Policy Directions,
* Medicaid Enrollment in 50 States: December 2006 Data Update, and
* State Children’s Health Insurance Program (SCHIP): Reauthorization History.

They can all be found online here, along with some key publications that explain the impact of federal fiscal relief for Medicaid in the last recession.

Knowing What Works in Health Care: A Roadmap for the Nation

January 30, 2008

Institute of Medicine. Knowing What Works in Health Care: A Roadmap for the Nation. Washington, DC: IOM, January 24, 2008.

Solutions to some of the nation’s most pressing health policy problems hinge on the ability to identify which diagnostic, treatment, and prevention services work best for various patients and circumstances. Spending on ineffective care contributes to rising health costs and insurance premiums. Variations in how health care providers treat the same conditions reflect uncertainty and disagreement about what clinical practice standards should be. Patients and insurers cannot always be confident that health professionals are delivering the most effective care.

A new Institute of Medicine report, Knowing What Works in Health Care: A Roadmap for the Nation, provides a blueprint for a national program to assess the effectiveness of clinical services and to provide credible, unbiased information about what really works in health care. The report recommends that Congress direct the U.S. Department of Health and Human Services to establish a program with the authority, expertise and resources necessary to set priorities for evaluating clinical services and to conduct systematic reviews of the evidence. The program would also develop and promote rigorous standards for creating clinical practice guidelines, which could help minimize use of questionable services and target services to the patients most likely to benefit.  Links to Abstract Report Brief Executive Summary and Press Release.

Cornell's Wex Collaborative Public Access Site Includes Health Law Resources

January 30, 2008

Wex is an ambitious effort to construct a collaboratively-created, public-access law dictionary and encyclopedia. It is sponsored and hosted by the Legal Information Institute at the Cornell Law School ( The health law section can be found here and includes relevant links to Federal constitution and statutes,Federal regulations, Federal judicial decisions, State statutes, State judicial decisions and related material.