Milbank Memorial Fund

For the third time since its enactment in 2010, the future of the Affordable Care Act (ACA) is on the line at the Supreme Court. This time, the Court will decide if the ACA’s individual mandate requiring that everyone maintain a minimum level of essential health insurance coverage is constitutional and whether only that provision, or the whole ACA, should fall. In a new Milbank Quarterly Opinion, Lawrence O. Gostin of the Georgetown University Law Center explains the Court’s options and why the ACA is unlikely to be struck down.

A new open-access Milbank Quarterly article finds that without proactive efforts to address digital barriers associated with socioeconomic status, the implementation of telehealth may reinforce disparities in health access among marginalized and underserved communities. Researcher Ji E. Chang of the New York University School of Global Public Health and colleagues analyzed data on small primary care practices’ use of telehealth and barriers to telehealth use in New York City following New York State’s pandemic stay-at-home order.

There is widespread interest in supporting housing initiatives for people experiencing homelessness as a pathway to more costeffective health care. To better understand the implementation challenges associated with Medicaid demonstration waivers for housing supports, a new "Milbank Quarterly" article examines the experience of four of the 11 states with such waivers: California, Illinois, Maryland, and Washington. Author Frank J. Thompson and colleagues at the Rutgers Center for State Health Policy identify multiple challenges to the successful implementation of these demonstration projects, and offer lessons from the four states.

Navigating government agencies when you need help can be a daunting task. In 2000, the Federal Communications Commission created 211, an easy-to-remember number reserved for helplines that offer information or referrals to health and social support programs. In Indiana, a nonprofit group managed the state’s 211 services until last year, when state leaders integrated 211 into the state Family and Social Services Administration (FSSA). A new article by Martha Hostetter and Sarah Klein explains that, in addition to giving Hoosiers a single point of entry to a wide range of services and supports, moving 211 into FSSA has offered state leaders a better understanding of the unmet needs of residents and enabled them to better coordinate between state agencies and community-based organizations.

Some states are measuring and reporting on rates of primary care spending as a portion of total health care spending, and setting primary care spending targets, to increase transparency and encourage greater primary care investment. Yet, even as the use of alternative payment models such as prospective per-patient case rates or performance incentive payments grows, there is little uniformity in how primary care spending, particularly non-fee-for-service spending, is track...ed and defined. A new report by Erin Taylor, Michael Bailit, and Deepti Kanneganti of Bailit Health, which builds on a Milbank report defining claims-based primary care spending, proposes a standard definition and measurement methodology for measuring non-claims-based primary care spending. This framework will allow policymakers to accurately quantify total investment in primary care and enable comparisons of spending across states and within a state by region, payer, and health care system

Like a polar bear pacing on a shrinking ice floe, much of US primary care seems trapped and at risk. In his latest "View from Here," Milbank Memorial Fund President Christopher F. Koller dives into the payment recommendations from the recent National Academy of Sciences, Engineering, and Medicine report on implementing high-quality primary care, which would help primary care make it to higher ground.

Few would have predicted the five states with the highest percentage of vaccine distribution by population as of January 2021: North Dakota, West Virginia, New Mexico, South Carolina, and South Dakota. In a new Milbank Quarterly Opinion, Gail Wilensky of Project Hope reviews state strategies for vaccine distribution, explaining that West Virginia used a decentralized system that allowed local hospitals or health departments to take charge and that relied on local pharmacies instead of large chains like CVS and Walgreens. By contrast, Massachusetts and Maryland, which did not fare well early in the pandemic, finely differentiated among those at risk and had fewer vaccination sites.

A new consensus report released this week by The National Academies of Science, Engineering, and Medicine from its Committee on Implementing High-Quality Primary Care which includes Milbank Memorial Fund President Christopher F. Koller offers a plan to implement high-quality primary care for everyone in the United States. Read that report and a JAMA Viewpoints from the report co-chairs and Koller that summarizes the report findings and recommended actions. The US should reaffirm its commitment to a strong foundation of high-quality primary care as a common good that is accessible to everyone, and should make implementation of high-quality primary care a priority for government and the private sector, the authors say.

Over the last 20 years, the Centers for Medicare and Medicaid Services (CMS) has three launched three primary care models designed to align multiple payers with Medicare: Comprehensive Primary Care, Comprehensive Primary Care Plus, and Primary Care First. State Medicaid agencies can be valuable participants in these models given that they are among the largest health care payers in a market and aa driver of a state’s health policy. A new brief by the Center for Health Care Strategies’ Greg Howe, Anne Smithey, and Rob Houston examines state Medicaid agencies’ decision-making around participating in federal models.