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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

Healthcare execs name UnitedHealthcare as the insurer they trust the least

Perennial insurance industry bad boy UnitedHealthcare continued to score at the bottom in the annual ReviveHealth National Payor Survey, which measures the opinions and attitudes of hospital and health system leaders who negotiate and/or approve managed care contracts with national health insurance companies.

Physician recruitment competition increases starting salaries and benefits

With future success on the line, healthcare systems and physician practices are racing to hire more new physicians than the competition, and the recruitment wars are pushing up starting salaries and benefits for doctors finds the latest Medical Group Management Association (MGMA) Physician Placement Starting Salary Survey.

Hospitals buying up physician practices increases cost of care, new study finds

Stanford researchers examined hospital claims for privately insured patients between 2001 and 2007 and found that what some health economists had warned does indeed seem to be true — hospital ownership of physician groups does seem to lead to more expensive care.

Estimated ACO numbers up to 520

Consulting firm Oliver Wyman’s ongoing tracking of the growth of accountable care organizations (ACOs) finds an additional 150 such payor-provider arrangements since its last report in July of 2013.

Premier asks CMS for ACO program changes

The structure of the current Medicare Shared Savings Program (MSSP) — the Centers for Medicare and Medicaid Services (CMS) accountable care organization (ACO) trial — has posed challenges for participating organizations, notes the Premier healthcare alliance of 2,900 U.S. hospitals and nearly 100,000 other providers in a letter to CMS Administrator Marilyn Tavenner.

Study finds disjointed care patterns in current Medicare ACO model

Holding organizations accountable for care utilization and outcomes while simultaneously allowing Medicare beneficiaries free access to any provider they want either inside or outside an Accountable Care Organization (ACO) is a problem, say critics of the government’s current ACO program. A new study published by JAMA Internal Medicine finds these critics may be right.

AHA warns that Pioneer ACO program is in danger unless changes are made

Few additional providers will sign up to participate in Medicare’s current Pioneer ACO Model or the Medicare Shared Savings Program unless changes are made to the design of these programs notes the American Hospital Association (AHA) in a letter to the Centers for Medicare and Medicaid Services (CMS) Innovation Center.

Insurer and healthcare provider form unique care coordination joint venture

Insurer Independence Blue Cross (Independence) and integrated care management company DaVita HealthCare Partners have jointly formed a new company, Tandigm Health, to deliver high-quality care at a lower cost in the Philadelphia area, a region with some of the highest healthcare costs in the nation.

Defying expectations, greater insurance coverage is linked to increased ED use

The hope that universal health insurance coverage will move healthcare delivery out of costly care settings like emergency departments (EDs) and into lower-cost primary care settings may not come true unless other barriers to primary care access also are addressed finds a new study.

CareMore, Emory to tackle reducing costs and improving outcomes in Georgia seniors

WellPoint Inc.’s Cerritos, Calif.-based subsidiary CareMore and Atlanta-based Emory Healthcare say they will team up to expand CareMore’s model of care management for Medicare Advantage patients in Georgia.