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Care Delivery

 

Primary care practices in Louisiana, Nebraska, North Dakota and New York’s Erie and Niagara Counties can now apply to participate in the second round of CMS’s Comprehensive Primary Care Plus (CPC+) model.

For the second time under the Trump administration, CMS has delayed the implementation date of bundled payments for cardiac care and an expansion of a joint replacement model, which are now due to begin Jan. 1, 2018, opening the door to additional changes, like making the models voluntary rather than mandatory.  

Two large hospitals in the Los Angeles area would be under the same parent organization under a proposed affiliation plan announced by Cedars-Sinai and Torrance Memorial Medical Center.

Geisinger Health System and insurer Highmark have signed a letter of intent for a new joint venture to develop a new clinical network and reimbursement in four Pennsylvania counties.

New renderings have been released of the new pediatric and obstetric hospital campus at Lucile Packard Children’s Hospital Stanford, which is now slated to open in December, five years after the groundbreaking for the facility. 

 

Recent Headlines

Need for real-world evidence in value-based care could be advantage for pharma

With more physicians employed in larger organizations than private practices, and those larger groups being more likely to be reimbursed through models which involve financial risk, more physicians are looking to real-world evidence to inform their clinical decisions—a shift which could be beneficial for pharmaceutical companies.

New Jersey law limits initial opioid prescriptions to five days

New Jersey has enacted what its governor calls the strictest anti-opioid law in the country, affecting how long the length of initial prescriptions and waiving prior authorization requirements for those seeking treatment for addiction.

Uninsured rate at 8.8 percent; high-deductible plans on the rise

The latest National Health Interview Survey figures on health coverage show the number of people without health insurance fell to a new low through the first nine months of 2016.

California insurers reported inaccurate provider info to regulators

According to a review released by the California Department of Managed Health Care (DMHC), 90 percent of California insurer reports on which providers were in their network contained inaccurate information.

Lower wages change utilization, even in employer-sponsored insurance plans

Workers who make $24,000 or less annually, but still have employer-sponsored health insurance, have higher hospital and emergency department admissions rates and lower utilization of preventive care compared to higher-paid coworkers.

Physicians warn Trump immigration order will worsen doctor shortage, affect care

Two University of Pennsylvania Medical Center physicians said suspending immigration from seven Muslim-majority countries will have a negative impact on graduate medical education (GME) and the U.S. healthcare system as a whole.

Major organizations aim to change prior authorization requirements

A coalition of medical organizations led by the American Medical Association has released a 21-point plan to change when health insurers require pre-approval before patients can receive certain treatments, drugs or devices.

Illinois governor proposing new pharmacy rules after risky drug combinations go unnoticed

In response to a Chicago Tribune investigation, Illinois Gov. Bruce Rauner is a backing of series of changes to the state’s oversight of pharmacies, including sending “mystery shoppers” to make sure pharmacists are warning customers when their prescriptions may have adverse effects when taken together. 

Anthem ending opioid treatment preauthorization nationwide

Anthem has reached a settlement with New York Attorney General Eric Schneiderman to end its policy requiring prior authorization for medication-assisted treatment (MAT) for opioid addiction.

CMS: 45% of provider locations in Medicare Advantage directories are inaccurate

A CMS review of provider directories set up by Medicare Advantage plans found many listed the wrong phone numbers or locations for physicians or incorrectly labeled physicians as accepting new patients.

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