Time To Focus On The ACA’s Sometimes Unheralded Virtue: Value-Based Care

After many years of working to improve health care, the president and CEO of the Blue Shield of California Foundation says that he is "convinced that orienting our system to incentivize better health outcomes—for families, individuals, and communities—is the only sustainable, long-term answer."

January 12, 2017

Oregon’s High-Risk, High-Reward Gamble On Medicaid Expansion

Health policy in Oregon is like football in the SEC: not only a contact sport but also a source of intense civic pride. The state's Medicaid expansion was similarly turbulent.

January 10, 2017

The Payment Reform Landscape: Early Progress And The Need For Better Tools To Measure Impact

The release on October 25, 2016 of results from the Health Care Payment Learning and Action Network’s (LAN) data collection effort underscores the nationwide commitment to reform the way the public and private sectors pay for health care services.

January 6, 2017

The Best-Laid Plans For Health Care

Tremendous uncertainty awaits, though I expect that we will see a slowing down of the repeal and replace process, with even the individual mandate persisting for some time; unmaking the Affordable Care Act without leaving millions stranded will be harder than the campaign may have suggested.

January 5, 2017

CMS Contractors’ Survey Research Illustrates Four Health Care Transparency Paradoxes

This article identifies what might be called four health care transparency paradoxes -- aspects of HHS transparency communications in which assumptions are contradicted by what consumers have told researchers.

December 28, 2016

The Demise of the Part B Demo: Doom For Value-Based Payment?

Despite widespread, bipartisan agreement that we should be paying for value, even with respect to drugs, the uproar over Part B shows there remains strong resistance to specific policies that attempt to move towards that goal.

December 27, 2016

Education, Health, And Behavioral Health: New Policy Priorities For Their Integration Emerge For 2017

Health reform proposals offered during 2017 should include incentives for health care systems to work collaboratively with schools and child care and early education (ECE) to improve child health outcomes. And mental health promotion should be considered a part of how success is defined in...

December 23, 2016

What’s Confusing Us About Mental Health Parity

Unless there is further guidance on this point, one thing will still confuse us -- people still won’t be access a number of cost-effective and evidence-based behavioral health services, and the role of MHPAEA in addressing this issue is unclear.

December 22, 2016

Breaking Down The Final 2018 Letter To Issuers

On December 16, the Centers for Medicare and Medicaid Services released its final 2018 Letter to Issuers in the Federally Facilitated Marketplaces. This post describes the letter, noting differences from last year’s version and the proposed letter issued in November.

December 19, 2016

The Final 2018 Notice Of Benefit And Payment Parameters (Part 2)

This post, the second on the 2018 Notice of Benefit and Payment Parameters, focuses on changes to benefit, eligibility, and enrollment standards; it also addresses the rules governing special enrollment periods and CO-OPs and briefly reviews the 2018 actuarial value calculator methodology.

December 18, 2016