The Engelberg Center for Health Care Reform at The Brookings Institution yesterday proposed a framework for sustainable cost savings in the U.S. health care system, which the authors estimate would produce net federal savings of at least $300 billion over 10 years. Proposed reforms include Medicare Comprehensive Care organizations, integrated systems or networks of providers that would accept case-based or bundled payment for services and be required to meet certain performance standards for full payment. Medicaid would transition state waivers to a standard process and infrastructure for reforms, and expand and make permanent the Financial Alignment Demonstration for Medicare-Medicaid dual eligible beneficiaries. Other proposals include capping the tax exclusion for employer-sponsored health insurance, and reforms aimed at system-wide efficiency such as an updated standardized claim form. The bipartisan group of authors includes former Centers for Medicare & Medicaid Services Administrator Mark McClellan, the center’s director; former secretaries of Health and Human Services Michael Leavitt and Donna Shalala; former Senate Majority Leader Tom Daschle (D-SD), and former director of the White House Office of Management and Budget Peter Orszag.

                     

HHS updates standards for culturally, linguistically appropriate care
                   

The Department of Health and Human Services’ Office of Minority Health has issued enhanced National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, and a blueprint with guidance and strategies to help implement them. The first update to the standards since their release in 2000 expands the concepts of culture, audience, health and recipients to reflect new developments and trends, and includes a focus on leadership and governance as drivers of culturally competent health care and health equity. 
                 

NIH awards $40 million in grants to reduce stroke disparities
                
The National Institutes of Health has announced that four research centers, including the University of Miami's School of Medicine, are to receive $40 million in funding over five years to develop culturally tailored interventions aimed at lowering stroke risk among U.S. racial and ethnic minorities,. The grant awards are contingent on the availability of funds from NIH’s National Institute of Neurological Disorders and Stroke, the agency said.  The other recipients are: Kaiser Permanente Northern California and the University of California, San Francisco; the Center for Stroke Disparities Solutions, a consortium led by NYU Langone Medical Center and Columbia University Medical Center; and the University of California, Los Angeles.  "Each program addresses disparity from a different perspective," said NINDS Program Director Salina Waddy, M.D. "One will address uncontrolled blood pressure and be delivered in an individual's home. Others will test community-based strategies to improve diet and exercise behaviors. Still others will bring into focus trends at the health care system and hospital levels."  The Florida Puerto Rico Collaboration to Reduce Stroke Disparities will leverage resources from University of Miami Miller School of Medicine, University of Puerto Rico, and Hospital HIMA-San Pablo Caguas, also in Puerto Rico. "Our mission is to improve the treatment and prevention of stroke among blacks and Hispanics in Florida and Puerto Rico," said Ralph L. Sacco, M.D., M.S., professor and chair of neurology at the University of Miami Miller School of Medicine.  The investigators will develop a registry of acute stroke patients treated at nearly 140 hospitals throughout Florida and Puerto Rico.  The hospitals are already using national guidelines and tracking their performance on key measures of stroke care quality such as the use of the clot-busting drug t-PA within three hours of stroke, and the initiation of other antithrombotic agents and smoking cessation counseling during hospitalization.  The researchers hope to gain a better understanding of the underlying factors that contribute to higher stroke risk among racial and ethnic minorities, and to identify opportunities for improvement.