What are the recent findings on health reform issues?

Recent Health Reform Research: Key Findings and Developments

Recent health reform research highlights the need for patient-centered care models, improved access to services, and systematic approaches to address healthcare disparities across various populations. 1

Patient-Centered Care and Outcomes

• Healthcare reform trends are increasingly emphasizing patient-centered outcomes, assessment and promotion of patient well-being, and shared decision-making with focus on quality of life outcomes 1
• Patient health status surveys should be incorporated into national surveillance of heart disease and stroke to ensure comprehensive assessment of cardiovascular health and treatment impacts 1
• Despite promising trends, optimal methods for collecting and integrating patient health status data into clinical practice remain undefined, making this a top priority for quality improvement and outcomes research 1

Access to Care and Service Delivery Models

• The Affordable Care Act (ACA) has established essential health benefits that include "rehabilitative and habilitative services and devices," which can significantly improve access to services like cardiac rehabilitation for low-income and underinsured populations 1
• Cardiac rehabilitation/secondary prevention programs (CR/SPPs) should be reengineered to include a wide array of service options that meet individual patient needs, providing more flexible programs within and beyond traditional clinical centers 1
• Health reform implementation provides opportunities for improving access to and quality of services under new care delivery models such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) 1

Addressing Healthcare Disparities

• CR/SPP referral, enrollment, program design, and adherence strategies should specifically target older patients, women, minorities, those with low socioeconomic status, individuals with lower education levels, and non-English speakers 1
• These populations often have a higher burden of comorbidities and risk factors, lower health literacy, lesser disease self-management skills, and are less likely to be referred to or enroll in important healthcare services 1
• Having health insurance, a regular physician, and a regular source of usual care are all associated with receipt of preventive health care and higher cancer screening rates 1

Systematic Approaches to Healthcare Delivery

• Quality-enhancing policies should include service referrals as "core" quality-of-care measures for hospitals with public reporting of each hospital's adherence to performance measures 1
• Social determinants of health (SDOH) are well-documented as influencing health inequities, and healthcare systems should assess food insecurity, housing insecurity/homelessness, financial barriers, and social support when making treatment decisions 1
• Successful care requires a systematic approach to supporting patients' behavior-change efforts, including high-quality self-management education and support 1

Cost Considerations and Financial Access

• The cost of medications, particularly insulin, remains an ongoing barrier to achieving treatment goals, with up to 25% of patients prescribed insulin reporting cost-related underuse 1
• Patients who have either private or public insurance coverage are more likely to meet quality indicators for care 1
• The Affordable Care Act and Medicaid expansion have resulted in increased access to care for many individuals with an emphasis on protection of people with preexisting conditions, health promotion, and disease prevention 1

Implementation Challenges

• The implementation of health status measurement in disease surveillance, while critical, faces challenges related to reliability and validity across populations and cultures 1
• Despite scientific evidence supporting benefits of services like cardiac rehabilitation, there remains a wide treatment gap in clinical implementation of such programs 1
• Screening rates are highest when strategies are in place that promote recruitment, referral, and appointment scheduling; reduce organizational interfaces required to complete screening; and promote continuous patient care 1

Future Directions

• Care teams should avoid therapeutic inertia and prioritize timely and appropriate intensification of lifestyle and/or pharmacologic therapy for patients who have not achieved recommended targets 1
• Building engagement through nationally adopted frameworks that outline plans to support welfare and protection is a powerful tool to ensure sustainability of processes to prevent institutionalization, enhance quality of alternative care, and preserve families 1
• Monitoring progress and identifying problems can be done more effectively using shared implementation frameworks and targets 1

Health reform continues to evolve with emphasis on addressing disparities, improving access, enhancing quality, and controlling costs through evidence-based approaches that prioritize patient outcomes and systematic care delivery.