HFMA NEWS

The number of underinsured adults rose by 60 percent between 2003 and 2007, from 16 million to more than 25 million, according to a new Commonwealth Fund study released June 10 as a Health Affairs web exclusive. Middle- and higher-income families were hit the hardest by the steep increase: Underinsurance rates nearly tripled for those with incomes above 200 percent of the federal poverty level (annual income of $40,000 or higher for a family).

In How Many Are Underinsured? Trends Among U.S. Adults, 2003 and 2007, Commonwealth Fund authors use 2007 national survey data to provide a national estimate of the number of adults who are underinsured, updating a 2003 study. The analysis finds that 25.2 million insured adults ages 19-64 were underinsured based on their out-of-pocket healthcare costs relative to their incomes. Including those who had any time without insurance during the year, the study estimates that 42 percent of adults age 19-64, or 75 million people, were either uninsured or underinsured during the year as of 2007, up from one-third in 2003.

The study found that despite the fact that the underinsured have health insurance all year long, they are at high risk of access problems and financial stress--with experiences often similar to those of the uninsured. The authors conclude that benefit designs that reduce cost sharing for high-value, cost-effective care and lower cost sharing for families with low and modest incomes will be necessary to achieve high-quality care and better health outcomes rather than just coverage. Read the abstract.

Department of Health and Human Services (HHS) Secretary Mike Leavitt on June 10 named 12 communities that will participate in a national Medicare demonstration project that provides incentive payments to physicians for using certified electronic health records (EHR) to improve the quality of patient care.

The communities selected to work with the Centers for Medicare and Medicaid Services (CMS) on the EHR demonstration project range from county and state level to multistate collaborations. They include Alabama; Delaware; Jacksonville, Fla. (multi-county); Georgia; Madison, Wis. (multi-county); Maine; Louisiana; Maryland/Washington, D.C.; Oklahoma; Pittsburgh (multi-county); South Dakota (multi-state); and Virginia.

Over the five-year demonstration project, financial incentives will be provided to as many as 1,200 primary care physician practices in the selected communities that use certified EHRs to improve quality as measured by their performance on specific clinical quality measures. In addition to the incentive payments, bonus payments may be awarded based on a standardized survey measuring the number of EHR functionalities a physician group has incorporated into its practice. Total payments under the demonstration for all five years may be up to $58,000 per physician or $290,000 per practice.

Findings from the demonstration will help determine the role of EHRs in delivering high-quality care and reducing errors; it will also assess the role of incentive payments in encouraging adoption and use of EHRs. Read the release.