Health Affairs

The Patient Protection and Affordable Care Act established a new public-private entity for comparative effectiveness research: the Patient-Centered Outcomes Research Institute. The institute is charged with identifying priorities, establishing an agenda, and carrying out comparative effectiveness research. The political process through which the institute was formalized greatly influenced its scope and charge, including the organization’s goals, its unique private-public composition, and its funding.

Abstract: The U.S. health care system too often falls short in delivering effective primary care, especially for patients with chronic conditions. One potential solution is the patient-centered medical home, a model that has shown success in individual demonstrations. Evidence from seven of the largest medical home pilots shows that four factors are essential: dedicated care managers; expanded access; performance management tools; and effective incentive payments.

Abstract: The journey of national health reform legislation from concept to President Barack Obama’s desk was long and winding, but not without important guideposts. Core elements of Massachusetts’ 2006 health reform—near-universal, affordable coverage; changes in the small-group and individual insurance markets; and an individual mandate to obtain insurance—provided a road map for policy makers charting national health reform. Our experience with the Massachusetts reform informed our work on the Senate Health, Education, Labor, and Pensions Committee in 2008 and 2009.

Expanding insurance coverage is a critical step in health reform, but we argue that to be successful, reforms must also address the underlying problems of quality and cost.

The United States appears headed toward another national debate about health system reform. Worry about access and health system deficiencies has reached critical mass, and polls indicate that health care leads the domestic agenda for the 2008 elections. This debate, like previous debates, will succeed or fail in Congress. We highlight key elements of recent sagas in health legislation and offer advice to the next president and Congress for improving the likelihood of a successful outcome in 2009-10:

Abstract: Before the crucial upcoming debate over reauthorization of the State Children’s Health Insurance Program (SCHIP) and all of the 10,000 general health reform questions that this discussion will engender, we should consider one fundamental moral question, for our answer will reveal the kinds of policies we actually want to pursue: Who should be allowed to sit at our health care table of plenty?