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Care Delivery

 

The goal of accountable care organizations (ACOs), according to CMS, is to better coordinate care for chronically ill patients, avoiding unnecessary services and preventing errors. For ACOs in the Medicare Shared Savings Program (MSSP), however, those weren’t the reasons they saved money, according to a study published in the Dec. 2017 issue of Health Affairs.

The offerings on the Affordable Care Act’s health insurance exchanges for 2018 are dominated by narrow network plans, with higher deductibles for silver- and gold-level plans, according to an analysis from Avalere.

Between 2006 and 2014, the number of emergency department (ED) visits paid for by Medicaid rose from 26.5 million to 44.1 million, making the program the most frequent payer in the ED over private insurance.

Fifteen new states will participate in the Medicare Advantage (MA) Value-Based Insurance Design (VBID) model for 2019, allowing insurers in a total of 25 states to enter the program aimed at encouraging enrollees to focus on services that are of the highest clinical value to their specific chronic conditions.

Several groups representing nurses have accused the American Medical Association of igniting a “turf war” and “hampering access to care” by adopting a resolution to oppose efforts to allow non-physician practitioners to practice independently without the supervision of a licensed physician.

 

Recent Headlines

ACA enrollment surges in first few days

The first few days of open enrollment on the Affordable Care Act’s exchanges saw more than 600,000 people sign up for coverage, up 79 percent from last year and setting a new record start for enrollment on Healthcare.gov.

20% of doctors want to reduce clinical hours

The prevalence of physician burnout could worsen the shortage of doctors in the U.S., according to an American Medical Association (AMA) survey which found nearly one out of five physicians want to cut back their clinical hours to part-time within a year, while others are thinking of retirement, pursuing a different kind of practice or leaving healthcare altogether.

CMS approves Medicaid waivers for opioid treatment in 2 states

Utah and New Jersey are the first states approved by CMS to design demonstration projects allowing Medicaid to pay for opioid addiction treatment, including enrollees residing in residential treatment facilities.

AMA: 83% of doctors see Medicaid patients

The Affordable Care Act (ACA) did change physicians' total patient mix by health insurance status, with the percentage of uninsured patients shrinking and the average Medicaid patient load increasing in states that expanded eligibility.

States looking beyond managed care to value-based models in Medicaid

State spending on Medicaid grew 3.9 percent while enrollment was up by 2.7 percent in fiscal year 2017, both well below the double-digit increases seen in the years immediately following the expansion of Medicaid eligibility under the Affordable Care Act ACA).

Come together: 5 things to know about forming a virtual group in MIPS

The second year of the Merit-based Incentive Payment System (MIPS) has proposed new option for participation, with clinicians able to join together in “virtual groups” to report on MIPS performance measures.

Millennials will dominate nursing profession by 2020

The average millennial—someone born between 1982 and 2000—is nearly twice as likely to become a registered nurse (RN) than a baby boomer, a “surprising surge of interest” potentially averting a large national shortage of nurses.

Freestanding ERs clustered in wealthier areas

In 2016, there were more than 200 freestanding emergency departments (EDs) in Texas, the center of a boom in these sites of care. With far fewer restrictions on where they can be built compared to hospital-based EDs, most of these facilities have been built in areas where residents have higher household incomes.

AHRQ: Nearly 70% of hospitals are in health systems

The 626 health systems in the U.S. accounted for the majority of hospitals, beds and discharges in 2016, according to data released by the Agency for Healthcare Research and Quality (AHRQ).

Wellness programs, new sites of care common among larger employers’ insurance plans

Group market insurance plans had premiums increase by an average of 3 percent this year, the sixth consecutive year of a single-digit hike and well below the 20 percent jump in non-group market premiums, while employers continue to search for ways to cut costs through different sites of care and wellness programs.

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