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This Viewpoint reviews the strategic plan of the Center for Medicare and Medicaid Innovation and explores the key takeaways of the plan. [ABSTRACT FROM AUTHOR]

Context: Little is known about nursing home residents' injuries that are inflicted by other residents. Objective: To assess risk factors for violent injury to nursing home residents by other residents. Design, Setting, and Subjects: Case-control study using data from the Massachusetts Department of Public Health's Complaint and Incident Reporting System and from Minimum Data Set assessments for Massachusetts nursing home residents. Cases had an injury sustained from an incident with another nursing home resident between January 1, 2000, and December 31, 2000, which left visible evidence (ie, fracture, dislocation, bruise or hematoma, laceration, and reddened area) (median age, 81 years). Controls were randomly selected from all residents who had a Minimum Data Set assessment completed in 2000 (n = 101 429) and no injury report (median age, 83 years). A total of 1994 controls were included in the analyses. Main Outcome Measures: Injury type and risk of being injured by resident-to-resident aggressive physical behaviors based on the specific characteristics of the injured resident. Results: During the first incident, 294 residents sustained fractures (n = 39), dislocations (n = 6), bruises or hematomas (n = 105), lacerations (n = 113), and reddened areas (n = 31). Injured residents (cases) were more likely to be cognitively impaired, exhibit symptoms of wandering, be verbally abusive, and have socially inappropriate behavior than the controls. Residents who were classified as needing extensive assistance (adjusted odds ratio [AOR], 0.3; 95% confidence interval [CI], 0.2-0.6) and being severely dependent (AOR, 0.12; 95% CI, 0.05-0.27) had a significant reduction in being injured. Residents in an Alzheimer disease unit were almost 3 times as likely to be injured than those living in other units (AOR, 3.2; 95% CI, 1.4-7.5). Conclusions: Injured residents were more likely, perhaps unknowingly, to "put themselves in harm's way," be verbally aggressive, and be cognitively impaired. Interventions to prevent these incidents should focus on the behavior of the injured persons. [ABSTRACT FROM AUTHOR]

The authors reflect on how the U.S. Affordable Care Act (ACA) has resulted in the implementation of prevention into a range of new medical care models. They comment on Title 4 of the ACA which focuses on improving public health and preventing chronic disease and how it has shown mixed results. They mention how the ACA has removed out-of-pocket costs as a barrier for patients accessing high-value, evidence-based clinical preventive medicine, and on cost sharing and Medicare services.

The article discusses a section in the Affordable Care Act (ACA) about shared responsibility for employers which will take effect on January 1, 2015. Topics discussed include the employer mandate's requirement for large employers to offer affordable minimum-value health insurance to employees and their dependents and the provision's aim to offset the public cost of subsidies to employees who are in need of health insurance.

The authors reflect on the significance of the reforms contained in the U.S. Affordable Care Act (ACA) and their implications for the U.S. health care system. They explain the plan to extend the guaranteed issue provision of the law which makes the practice of selective medical underwriting illegal. They also discuss issues related to the implementation of the individual shared responsibility provision and Medicaid expansion.

Presents the authors' reply to a letter to the editor in reference to the article entitled "Resident-to-resident violent incidents in nursing homes," by T. Shonoda-Tagawa et al.