In Senate Health Care Bill, A Few Hidden Surprises

With legislation that governs one-sixth of the US economy and that directly affects the health and economic security of millions of constituents, Senators are being asked to vote largely in the dark.

July 13, 2017

Beyond ‘Repeal and Replace’: Physicians Renew The Call For Delivery System Improvement

Policymakers who are focused predominantly on how to improve the health care system by providing health insurance coverage will fail unless they simultaneously focus on transforming and modifying the delivery system.

July 12, 2017

CMS Releases 2016 ACA Marketplace Reinsurance And Risk Adjustment Data

On June 30, 2017, CMS released the results for the third year (2016) of the reinsurance and risk adjustment programs, two of the Affordable Care Act’s “three R” premium stabilization programs. The 2016 results from the risk corridor program, the “third R” will be announced later this year.

July 1, 2017

State Single Payer And Medicaid Buy-In: A Look At California, New York, And Nevada

As more states seek to develop their own unique systems and solutions, we appear to be in a time where states are truly the laboratories of health care policy.

June 30, 2017

Growth Of ACOs And Alternative Payment Models In 2017

Since the first quarter of 2016, 138 new ACOs began operation, and 46 ACOs dropped their accountable care contracts, representing 11 percent growth.

June 28, 2017

How Could The 21st Century Cures Act And The Joint Commission Improve Eating Disorder Care?

With the potential for increased coverage of eating disorder treatment through parity clarification and appropriate federal regulations, there will be a burgeoning interest in quality performance from regulators, payers, and the public.

June 28, 2017

The Downstream Consequences Of Per Capita Spending Caps In Medicaid

From the lens of economics, we draw an analogy to per capita payments in health insurance markets and explain how the currently proposed reforms threaten the core programmatic purpose of Medicaid by incentivizing states to limit care and coverage to the states’ most vulnerable residents.

June 26, 2017

The Payment Reform Landscape: Is The Debate Over Retrospective Versus Prospective Bundled Payments A Distraction?

Setting a prospective target budget, instituting reasonable downside financial risk, and tying final payment amounts to performance on a set of outcome measures all provide powerful incentives to manage patients well while adhering to a budget.

June 23, 2017

At Drug Hearing, Senators Discuss Meanings Of Price And Value—And Debate Health Reform

On Tuesday, June 13, the Senate HELP Committee held the first of three planned hearings on high drug prices. One of the most important points to come out of the hearing was that there is bipartisan concern about high drug prices, even if there is as yet little agreement on what to do about them.

June 20, 2017

Savings Reported By CMS Do Not Measure True ACO Savings

The bottom line is that we should not pay attention to any analysis that uses the benchmarks as the basis for assessing the effects of accountable care organizations on Medicare spending.

June 19, 2017