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The ACO Delusion
By ANISH KOKA, MD
Accountable care organizations (ACO’s) promise to save us. Dreamed up by Dartmouth’s Eliot Fisher in 2006, and signed into law as a part of the Patient Protection and Affordable Care Act (PPACA) in 2010, we have been sold on the idea that this particular incarnation of the HMO/Managed Care will save the government, save physicians and save patients all at the same time. I dare say that Brahma, Vishnu and Shiva together would struggle to accomplish those lofty goals. Regardless of the daunting task in front of them, the brave policy gods who see patients about as often as they see pink...
Source: The Health Care Blog - April 25, 2016 Category: Consumer Health News Authors: John Irvine Tags: THCB Uncategorized ACO Anish Koka Source Type: blogs
Compromise Prospects Recede In Contraceptive Mandate High Court Litigation (Update)
Implementing Health Reform (April 22 update). On April 21, the Centers for Medicare and Medicaid released drafts of six updated federal standard notices to be used by insurers in the individual market when they discontinue products or renew coverage at the end of a coverage year, or non-renew or terminate coverage because an enrollee has moved out of a product’s service area. CMS update notices released in 2014.
For policy years ending before December 31, 2017, insurers may use either the 2014 or updated notices, but for policy years ending on or after that date the updated notices will be required. CMS is requesting co...
Source: Health Affairs Blog - April 21, 2016 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Mental Health MHPAEA Substance Use Disorders Source Type: blogs
Panel Discussion on Medicare Part B Drug Payment Model Demonstration
Conclusion
Dr. Conway mentioned that CMS is actively monitoring the situation and creating a plan for the demonstration, and believes that success will involve improved quality and neutral costs, or even improved quality and reduced costs, and that either result would be considered a success.
Related StoriesMedPAC Meeting on Part B Drug Payment PolicyMedPAC Votes for Sweeping Revisions to Medicare Part DCourts to Finally Take Up CMS Recovery Audit Contractors Appeals Backlog
Source: Policy and Medicine - April 14, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Tracking The Impact Of The Affordable Care Act In Kentucky
The Affordable Care Act (ACA) presents states with an opportunity to tailor the implementation of key health policy approaches intended to increase health insurance coverage and access to timely, high-quality care in a way that fits their populations best.
Kentucky may well be one of the most interesting cases to watch and learn from as we seek to understand how the ACA can make us healthier while controlling costs and improving quality of care. The Foundation for a Healthy Kentucky has been tracking the impact of the ACA on coverage, access, costs, quality of care, and health outcomes through a multiyear contract with ...
Source: Health Affairs Blog - April 6, 2016 Category: Health Management Authors: M. Gabriela Alcalde Tags: Costs and Spending Featured GrantWatch Insurance and Coverage Medicaid and CHIP Quality Access Affordable Care Act Disparities Health Care Costs health outcomes Health Philanthropy Health Reform Kentucky Policy Source Type: blogs
Time to Fashion A Quilt From The Patchwork Of Advance Care Planning
Discussions Saved Her Life.” The article’s positive message was received by CMS leadership and further amplified by public comments to CMS that were overwhelmingly in favor of Medicare payment for end-of-life discussions.
Not long after, CMS announced the new payment codes. That announcement was, as Tuller wrote, an important first step.
It’s time to take up the gauntlet and turn the best practice of advance care planning into common practice.
Related reading:
“Live Well, Die Well: Thoughts on the Best Care Possible through the End of Life,” by Erica Hallock of Empire Health Foundation, GrantWatch section...
Source: Health Affairs Blog - March 29, 2016 Category: Health Management Authors: Amy Berman Tags: Featured Health Professionals Medicare advance care planning Aging Aging and Health Consumers Coverage End-of-Life Care Health Philanthropy Palliative Care Physicians Source Type: blogs
Value Pricing For Drugs: Whose Value, What Price?
It is hard to read a newspaper these days without coming across a story about the high and ever increasing cost of drugs. The Wall Street Journal named drug prices the top health story of 2015. Stories about drug prices fall into two general categories. The first are stories about generic and other manufacturers who are not focused on innovation (like Turing Pharmaceuticals and Valeant) but who acquire generic drugs and increase the price dramatically without adding value while also making it impossible for competitors to manufacture the drug by controlling the distribution.
While this problem is real, it is not the focus ...
Source: Health Affairs Blog - March 28, 2016 Category: Health Management Authors: Robert Rubin Tags: Costs and Spending Drugs and Medical Technology Featured Medicare ACOs Big Pharma cost effectiveness analysis high-cost drugs PCSK9 inhibitors QUALY value-based payment Source Type: blogs
Lung Cancer Screening Tools for Patients and Clinicians
New tools from the Agency for Healthcare Research and Quality (AHRQ) can help longtime smokers between the ages of 55 and 80 make informed decisions with their health care provider on whether to get screened for lung cancer with low-dose computed tomography (LDCT). The online tools are designed to support discussions between patients and providers about whether lung cancer screening is appropriate, as well as about the possible benefits and harms of screening using this method. LDCT is the only recommended screening test for lung cancer. The tools are designed for diverse users: http://1.usa.gov/1o76Za7, and printed versi...
Source: BHIC - March 23, 2016 Category: Databases & Libraries Authors: Patricia Devine Tags: General Minority Health Concerns Source Type: blogs
Don’t Let the Talking Points Fool You: It’s All About the Risk Pool
Most people are healthy most of the time, and as a consequence, health care expenditures are heavily concentrated in a small share of the population: about 50 percent of the health care spending in a given year by those below age 65 is attributable to just 5 percent of the nonelderly population. The lowest spending half of the population accounts for only about 3.5 percent of health care spending in a year.
Deciding how much of total health care expenditures should be shared across the population and how to share it is the fundamental conundrum of health care policy. There is more risk pooling the larger the share of healt...
Source: Health Affairs Blog - March 15, 2016 Category: Health Management Authors: Linda Blumberg and John Holahan Tags: Costs and Spending Equity and Disparities Featured Insurance and Coverage Medicaid and CHIP Medicare community rating Employer-Sponsored Insurance experience rating guaranteed issue and renewal health savings accounts high-risk pools Source Type: blogs
A New Federal Agency to Oversee Patient Safety?
By TEJAL GANDHI, MD
Patient safety should be a major priority for the United States, and that requires designating a centralized entity or coordinating body to oversee efforts to ensure it. Such centralized oversight is one of the key recommendations of “Free from Harm,” a report published in December by the National Patient Safety Foundation. The report highlights the need to create a safety culture, since preventable medical errors in hospitals are estimated to result in as many as 440,000 deaths annually. That would make it the third leading cause of death – after heart disease and cancer.
A new report by the U.S...
Source: The Health Care Blog - March 10, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized National Patient Safety Foundation Source Type: blogs
Health Wonk Review: Tales of the Trump
Had enough of Donald Trump by now? Well, you’d better do something about it unless you want to have to listen to him for another four years or more. I start this Health Wonk Review off with a couple Trumpy topics before moving on to the usual wonkery.
Trump may be the first major party candidate with fascist tendencies, but his healthcare proposals are just the usual Republican pap with a few pieces of Obamacare and socialism thrown in for good measure. NCPA’s Health Policy Blog gives us the rundown.
As Health Care Renewal tells it, many nutritional supplements are akin to the old snake oil remedies. Cons...
Source: Health Business Blog - March 10, 2016 Category: Health Management Authors: dewe67 Tags: Blogs Policy and politics Source Type: blogs
CMS Proposed Rule Drastically Changes the Way Medicare Pays for Part D Drugs
The Centers for Medicare and Medicaid Services announced their proposal to test new Medicare Part B prescription drug models in an attempt to "improve quality of care and deliver better value for Medicare beneficiaries." The proposal is part of the Obama Administration's broader strategy to encourage better care, smarter spending, and healthier people by paying providers for "what works, unlocking health care data, and finding new ways to coordinate and integrate care to improve quality."
The proposed rule proposes six changes: change the ASP, eliminate patient drug cost-sharing, provide evidence-based clinical decision ...
Source: Policy and Medicine - March 10, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
New Health Care Symposium: Health Care Consolidation And Social Justice—Unanswered Questions
Editor’s note: This post is part of a Health Affairs Blog symposium stemming from “The New Health Care Industry: Integration, Consolidation, Competition in the Wake of the Affordable Care Act,” a conference held recently at Yale Law School’s Solomon Center for Health Law and Policy. Links to all posts in the symposium will be added to Abbe Gluck’s introductory post as they appear, and you can access a full list of symposium pieces here or by clicking on the “Yale Health Care Industry Symposium” tag at the bottom of any symposium post.
How will health care consolidation affect health and health ca...
Source: Health Affairs Blog - March 7, 2016 Category: Health Management Authors: Michael Ulrich Tags: Equity and Disparities Medicaid and CHIP Population Health Public Health Baltimore clean water Flint insurer consolidation Lead poisoning medical legal partnerships Social Determinants of Health Yale Health Care Industry Symposium Source Type: blogs
Quality v. Quantity
By MICHEL ACCAD, MD
Impactful news today: Physicians, CMS and major commercial plans, announce simplification of quality measures. "Huge step forward" #aafp
— Andy Slavitt (@ASlavitt) February 16, 2016
A few weeks ago, the medical community received unexpected good news from the government about a “simplification of quality measures:”
Strictly speaking, and contrary to what Mr. Slavitt’s tweet would lead us to believe, the agreement to the new rules was primarily between commercial insurers and CMS, the Center for Medicare and Medicaid Services. Physicians were not actually party to the deal.
N...
Source: The Health Care Blog - March 4, 2016 Category: Consumer Health News Authors: Simon Nath Tags: THCB Andy Slavitt CMS MICHEL ACCAD Quality Source Type: blogs
CMS Releases Final 2017 Letter To Issuers In The Federally Facilitated Marketplaces (Updated)
Implementing Health Reform (March 3 update). On March 3, 2016, the Office of the HHS Assistant Secretary for Planning and Evaluation (ASPE) announced that the ACA has resulted in gains in health insurance coverage of 20 million adults through February 22, 2016. This includes 2.3 million young adults who gained coverage under the ACA provision allowing young adults to remain on their parents’ coverage through age 26, and 17.7 million non-elderly adults who have gained coverage between the beginning of open enrollment in October 2013 and the present. The report shows continued progress since ASPE released its last estimat...
Source: Health Affairs Blog - March 3, 2016 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Alaska Medicaid expansion QHPs Supreme Court Source Type: blogs
