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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

Large consumer survey finds that patients link billing experience to perception of care quality

In a national online survey of healthcare consumers, two thirds reported consistently being surprised by medical bills despite the fact that nearly all desired upfront cost estimates and valued these nearly as much as other clinical factors in their decision making, including outstanding bedside manner, prompt test results and accurate diagnoses.

Consumer advocacy group launches campaign to shame 20 health systems into ending bus screenings for heart conditions

Public Citizen, a consumer advocacy group that claims more than 300,000 members and supporters, on Thursday shared 20 letters it had sent to 20 hospitals and health systems in eight states asking them to end their relationships with HealthFair, a Winter Park, Florida-based company that provides cardiovascular health screenings on buses.

MedPAC June report proposes per-beneficiary payment for primary care

The Medicare Payment Advisory Commission (MedPAC) has a new idea for what should replace the primary care bonus that is set to expire in 2015: Pay primary care physicians a set fee for every Medicare patient that is part of their panel.

Will healthcare providers become social safety net providers, too?

A new report from the Commonwealth Fund lays out the economic incentive the Affordable Care Act (ACA) creates for healthcare providers to address social disparities along with medical needs.

Surgeons largely left out of ACO efforts

Although surgical procedures are among the most expensive of claims, Accountable Care Organization (ACO) cost reduction efforts don’t pay much attention to surgery as an area where possible waste in healthcare delivery may occur finds a new study published in Health Affairs.

Anthem/HealthCare Partners ACO says it saved $4.7 Million in California healthcare cost in just six months

The analysis of healthcare spending by Anthem Blue Cross and HealthCare Partners in California offers one of the first large documented examples of how accountable care organizations (ACOs) may trim costs in the commercial PPO population.

Hospital saves $500,000 in fall prevention but sees little of savings itself

Simple low-cost changes can make a big difference in the overall cost of care is what New Hanover Regional Medical Center in Wilmington, North Carolina, recently found when it crunched the number on its Lean management effort in fall prevention. However, it also found that most of those savings went to the government, insurers and patients, and not the hospital.

AHRQ publishes tool to reduce hospital readmissions

A key quality measure for many payment systems is a hospital’s rate of preventable readmissions, and the Agency for Healthcare Research and Quality (AHRQ) new Re-Engineered Discharge (RED) Toolkit aims to help institutions improve their numbers.

4 ideas for better integration of palliative care in medicine

Medicine as practiced today has lost its acceptance of the finite nature of human life and this is leading to negative consequences for elderly patients with multiple health problems, argues physician and nurse palliative care experts a Health Affairs commentary.

Expand audience for healthcare price data urges policy center

A new analysis by the Gary and Mary West Health Policy Center finds that moving beyond just encouraging patients to shop for healthcare services and also involving ordering physicians, employers and policymakers in healthcare spending decisions could save $100 billion over 10 years.