A Blueprint for U.S. Health Insurance Reform.

The current U.S. health insurance "system" was not deliberately planned and constructed but has emerged piecemeal over the past half-century through a series of incremental and haphazard reforms. That policy history also reveals a clear but unfulfilled societal commitment to providing access to essential health care regardless of resources. To fulfill this obligation, the solution proposed in this article has 2 key elements: 1) universal coverage that is automatic, free, and basic, and 2) the option to buy supplemental coverage in a well-designed market. Such a system could, if desired, be created without raising taxes and without disrupting or changing the delivery of medical care.

The Camden Coalition Care Management Program Improved Intermediate Care Coordination: A Randomized Controlled Trial.

When a randomized evaluation finds null results, it is important to understand why. We investigated two very different explanations for the finding from a randomized evaluation that the Camden Coalition's influential care management program-which targeted high-use, high-need patients in Camden, New Jersey-did not reduce hospital readmissions. One explanation is that the program's underlying theory of change was not right, meaning that intensive care coordination may have been insufficient to change patient outcomes. Another explanation is a failure of implementation, suggesting that the program may have failed to achieve its goals but could have succeeded if it had been implemented with greater fidelity. To test these two explanations, we linked study participants to Medicaid data, which covered 561 (70 percent) of the original 800 participants, to examine the program's impact on facilitating postdischarge ambulatory care-a key element of care coordination. We found that the program increased ambulatory visits by 15 percentage points after fourteen days postdischarge, driven by an increase in primary care; these effects persisted through 365 days. These results suggest that care coordination alone may be insufficient to reduce readmissions for patients with high rates of hospital admissions and medically and socially complex conditions.