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Care Delivery

 

Anthem has been criticized and even sued over policies in several states where it won’t pay for emergency room visits it later determines to be unnecessary. The insurer has now softened those restrictions, but American College of Emergency Physicians (ACEP) said the changes don’t go far enough.

Purdue Pharma, best known for making and selling OxyContin, announced Feb. 10 that it will stop marketing opioid drugs to physicians. The company also stated it will lay off half of its sales force, with the remaining staff of 200 focusing on other medications.

Medicaid patients face a host of challenges in accessing care, with reliable, timely transportation often being a major consideration. A recently published study, though, showed rates of missed primary care appointments were unaffected when Medicaid patients were offered free ridesharing services.

Some 11.8 million people signed up for coverage through the Affordable Care Act (ACA)’s insurance exchanges for 2018, down from 12.2 million the year before. Considering changes that were expected to depress enrollment—like HHS shortening the open enrollment period for Healthcare.gov and cutting its advertising budget by 90 percent—signups “remained generally stable,” according to a report from the National Academy for State Health Policy (NASHP).

In 2011, as outlined in the Affordable Care Act (ACA), Medicare began offering wellness visits at no cost to fee-for-service beneficiaries. The goal of the annual checkup was to introduce preventative care and address specific risks such as depression and risk of falling.

 

Recent Headlines

40% of adults enrolled in high-deductible insurance plans

A recent survey shows an increasing number of adults were enrolled in health plans with deductibles above $1,300 for individual plans and $2,600 for family coverage in 2016 as more employers turn to plans with higher out-of-pocket costs.

$155M cancer pavilion expansion begins at Henry Ford Health

Detroit’s Henry Ford Health System has broken ground on a $155 million expansion of its cancer institute, to be named the Brigette Harris Cancer Pavilion.

Med school enrollment up 28% since 2002, but residency slots may not be keeping pace

First-year enrollment at medical schools in the U.S. has gone up by 28 percent since 2002, but schools have told the American Association of Medical Colleges (AAMC) they have concerns there aren’t enough residency slots to match that growth.

MidMichigan Health plans to build $57 million cardiovascular center

MidMichigan Health is hoping to begin a $57 million construction project at its flagship campus in Midland in fall 2017 to build a new heart and vascular center.

CPC+ applications open for second round

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.

CMS pushes back cardiac, orthopedic bundles to 2018

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.  

Cedars-Sinai, Torrance Memorial propose affiliation

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, Highmark pursuing joint venture on new care model

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 Stanford children’s hospital set to open in December

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. 

ACO achieved sustainable cost reduction through care management program

By focusing on beneficiaries with high risks of future spending and steering care away from emergency departments, one participant in the Pioneer ACO model offered a scalable program which can achieve sustainable decreases in care costs, according to a study in the May 2017 issue of Health Affairs.

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