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Care Delivery

 

The number of counties at risk of having no insurer on their Affordable Care Act (ACA) exchange has fallen to just two, with Centene stepping in to cover potentially bare counties in Nevada.

The idea of a national, single-payer healthcare system is as divisive as ever to people within the industry, according to a new survey from cloud-based researcher company Reaction Data.

When asked to identify what regulations are the most burdensome, physician practices pointed at the Merit-based Incentive Payment System (MIPS) being implemented as part of the Medicare Access and CHIP Reauthorization Act (MACRA).

Insurance giant Anthem continued its departure from Affordable Care Act (ACA) exchanges, announcing it will no longer offer plans in Nevada and 74 counties in Georgia.

CMS has approved a five-year extension of Florida’s statewide Medicaid managed care demonstration, including $1.5 billion in funding for support uncompensated care for low-income patients.

 

Recent Headlines

Highmark May Gain Additional Leverage With Blues Merger

A merger agreement between Blue Cross of Northeastern Pennsylvania (BCNEPA) and Highmark Inc. could bring together two of Pennsylvania’s leading not-for-profit health insurance companies and become a factor in the long-running dispute between Highmark and UPMC, the region's largest health system.

BCBS of Michigan Adds Five Hospital Systems to New Reimbursement Model

Five hospital systems that together represent 24 Michigan hospitals have joined or expanded their participation in Detroit-based Blue Cross Blue Shield of Michigan’s value-based hospital reimbursement model. Similar to the accountable care organization (ACO) idea of lowering costs while improving quality through better care coordination and a focus on outcomes, the new model requires the hospitals to “identify their provider partners in the community and work with them to develop and implement an infrastructure plan that includes an all-patient registry system that allows caregivers at the hospital and in the physician offices to measure an individual’s health performance against similar populations.”

Early Medicare ACO Results Mixed

According to the Centers for Medicare and Medicaid Services (CMS), one year into the Medicare Accountable Care Organization (ACO) initiative, a little less than half (54) of the 114 participating organizations have achieved savings and of those, just 29 saved enough money to receive “shared savings” bonuses. In addition, an in-depth savings analysis for the 29 participating Pioneer ACOs showed that nine achieved significant savings while also scoring high quality metrics.

21 Hospitals Enter Phase 2 in Bundled Prospective Payment Bet

Among the 232 health care providers that have entered into agreements in the now 1-year-old Centers for Medicare & Medicaid Services (CMS) Bundled Payments for Care Improvement initiative, 21 acute care hospitals have begun the second phase of the payment model that is the cleanest break with traditional fee-for-service.

Medicare Shared Savings ACOs: Crystal Run Shares Lessons Learned

Change isn’t easy, especially when it affects how much you are paid for services rendered. But the writing on the wall is clear: the fee-for-service model, especially for Medicare patients, is slowly but surely disappearing into the Affordable Care Act sunset. What’s a physician to do: work more and get paid less?

Supporting Value-based Care: UPMC’s Telehealth Strategy

Can a physician adequately serve multiple patients—in four or more different locations—in the same morning? Andrew R. Watson, MD, MLitt, FACS, knows the answer is yes because he has done it. Executive director of telemedicine for the University of Pittsburgh Medical Center (UPMC), and a practicing colorectal surgeon, Watson has found that his real world experience prepares him well for the naysayers—but patients are not among the skeptics.

Partner in Population-health Management: Walgreens, Anyone?

When Robert London, MD, received a phone call from an executive recruiter who suggested that he interview for a position at Walgreens, he was flabbergasted. “I wondered what I was going to do,” he recalls. “Would I stand at the door and greet people? Let them know about a new shade of nail polish?”

Peeling Off a Service Line How Hoag Reinvented Orthopedics

If Richard Afable, MD, MPH, president and CEO of Hoag Memorial Hospital Presbyterian, Newport Beach, California, told you he was closing down one of the largest orthopedics programs in California and entering into an orthopedics specialty hospital joint venture with his physicians, you might think about sending him job leads.

ACOs: Help or Headache?

Opinions about health care reform are plentiful, but Thomas H. Lee, MD, would rather hear solutions. When last year’s Affordable Care Act offered a new model called accountable care organizations (ACOs), Lee assessed the entity’s viability in his role as network president of Partners HealthCare System, based in Boston, Massachusetts.

Turnover and Retention Management in the Era of Reform

It's no secret that health care is undergoing tectonic changes, and as health care organizations struggle to keep pace with a rapidly evolving environment, there's never been a more critical time for the industry to develop and grow its competent leaders, says Tim Butler, senior consulting manager for GE Healthcare's Performance Solutions business.

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