The Most-Read Health Affairs Blog Posts Of 2019

Susan DeVore’s look at trends to watch in 2019 was the most-read Health Affairs Blog post of the year, heading a list that also included several posts exploring social determinants of health and two entries from Katie Keith’s chronicling of all things ACA. Rounding out on our top ten: posts on maternal mortality, alternative payment models, vaccine rates, and hot topics for health policy researchers and analysts.

Check out our list of most-read Health Affairs articles for 2019, published on Monday. And watch for coming lists of our most-shared articles, our “Editor’s Picks” from Health Affairs Editor-in-Chief Alan Weil, and our most-read GrantWatch posts. To our readers, our thanks and best wishes for a happy New Year!  

1. Health Care In 2019: Five Key Trends To Watch
Susan DeVore, January 10, 2019

In the latest installment of her annual Health Affairs Blog posts looking forward to the year to come, DeVore laid out what to watch for in health care and health policy. She suggested 2019 would bring developments such as a “tipping point” for the shift into alternative payment models and two-sided risk arrangements, as well as increased physician participation in and leadership of this shift; disruptive innovation from both new entrants and incumbents in the health care market; stepped-up reforms in the pharmaceutical market; and a markedly greater role for digital technologies, particular artificial intelligence and predictive analytics, in health care.

2. Meeting Individual Social Needs Falls Short Of Addressing Social Determinants Of Health
Brian Castrucci and John Auerbach; January 26, 2019

Social needs “are further upstream than medical interventions, but not yet far enough. Social needs are the downstream manifestations of the impact of the social determinants of health on the community,” Castrucci and Auerbach wrote. Actions by health providers to meet the non-medical needs of individual patients are important and potentially life-saving, but “improvements in our nation’s health can be achieved only when we have the commitment to move even further upstream to change the community conditions that make people sick” through policy changes.

3. Final Rule On Health Reimbursement Arrangements Could Shake Up Markets
Katie Keith; June 14, 2019

As part of her comprehensive coverage of the Affordable Care Act under Health Affairs Blog’s “Following The ACA” track, Katie Keith examined a final rule that reversed earlier federal guidance and expanded the ability of employers to use health reimbursement arrangements to fund premiums for their employees in the individual health insurance market. The HRA rule completed the “regulatory trifecta” from President Trump’s October 2017 executive order; it followed earlier final rules on short-term coverage and association health plans, both of which Keith also analyzed in HA Blog posts.

4. Standardizing Social Determinants Of Health Assessments
Douglas P. Olson, Benjamin J. Oldfield, and Sofia Morales Navarro; March 18, 2019

Olson and coauthors dug into the details of how to address social determinants of health. They noted three challenges: lack of a standardized screening tool for social determinants in the electronic health record; reliance solely on clinical provider staff to screen and document for social determinants; and lack of a standardized crosswalk between social determinants and diagnostic codes for documentation. The authors discussed how systems might overcome these challenges, based on their experiences at Fair Haven Community Health Care in New Haven, Connecticut.

5. Unpacking The Executive Order On Health Care Price Transparency And Quality
Katie Keith; June 25, 2019

A second Katie Keith post in the top ten looked at another Trump administration executive order. This order, from June 24, 2019, concerned transparency regarding health care prices and quality, a topic that has been in the news lately as the administration just extended the deadline for comment on a proposed health insurer transparency rule. (A transparency rule for hospitals has already been finalized.) In her post, Keith discussed the contents of the June executive order and noted that rules implementing the order could be challenged in court, as indeed has occurred with the hospital transparency rule.

6. When Talking About Social Determinants, Precision Matters
Katie Green and Megan Zook; October 29, 2019

In the third post on social determinants to make the top ten, Green and Zook stressed the need for care in discussing, and distinguishing among, terms such as social determinants of health, social risk factors, and social needs. They advocated cross-sector partnerships to address social determinants: “Our nation’s growing health care costs and poor outcomes, including a maternal mortality and morbidity crisis, are evidence that [a] siloed approach isn’t working.”

7. The United States Maternal Mortality Rate Will Continue To Increase Without Access To Data
Rachel Mayer, Alison Dingwall, Juli Simon-Thomas, Abdul Sheikhnureldin, and Kathy Lewis; February 4, 2019

Maternal mortality rates in the United States have doubled over the last two decades, and non-Hispanic black women are four times as likely to die a pregnancy-related death than non-Hispanic white women. Yet the high-quality, timely data needed to attack this problem are too often lacking. Mayer and coauthors surveyed the available data sources on maternal mortality and drew lessons from California’s efforts to improve its data in this area—efforts that have helped the state reduce maternal mortality rates by 55 percent over seven years.

8. North Carolina: The New Frontier For Health Care Transformation
Mark B. McClellan, Mathew Alexander, Mark Japinga, and Robert S. Saunders; February 7, 2019

McClellan and coauthors observed that North Carolina was moving beyond incremental progress on alternative payment models and stood “on the verge of something different: a set of reforms that would create an unprecedented, accelerated shift in how health care is paid for in the state, and the way social risk factors are incorporated in health care payment and delivery systems. Over the next five years, the state is poised to make an estimated 70 percent or more of health care payments through alternative payment models.” The authors summarized these reforms and discussed how challenges to their implementation might be met.

9. Vaccine Exemptions And The Federal Government’s Role
Richard Hughes IV; March 21, 2019

Hughes noted the increase in measles cases, which is often linked to exemptions from vaccine requirements. After surveying the history of federal and state efforts to increase vaccine rates and laying out possible federal strategies moving forward, he concluded: “The approach most likely to succeed (legally and politically) is the one the CDC took 60 years ago when it encouraged states to implement stricter vaccination requirements." 

10. Three Hot Topics For The Health Policy Research Community In 2019
Lisa Simpson; January 24, 2019

Simpson identified three “hot topics” that would continue to demand action, and evidence to guide such action, in 2019: health care spending, delivery system transformation, and public health challenges. Consistent with her role as CEO of AcademyHealth, Simpson outlined initiatives within the health policy research and analysis communities that could help meet the demand for rigorous, timely evidence to inform policymakers.