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PricewaterhouseCooper’s (PwC) Health Research Institute expects “persistent risks and uncertainties” to impact healthcare in 2017, ranging from policy changes under the Trump administration to how artificial intelligence (AI) will change workflows—and in the end, it may come out stronger because of those challenges.

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.

 

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5 top issues for the healthcare industry in 2018

PricewaterhouseCooper’s (PwC) Health Research Institute expects “persistent risks and uncertainties” to impact healthcare in 2017, ranging from policy changes under the Trump administration to how artificial intelligence (AI) will change workflows—and in the end, it may come out stronger because of those challenges.

ACO savings aren’t driven by better care coordination of high-risk patients

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.

Narrow network plans make up 73% of ACA exchange market

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.

Medicaid surpassed private insurance as biggest ER payer

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.

Medicare Advantage value-based design expanded for 2019

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.

‘Turf war’ erupts between nurses, AMA on role of non-physician practitioners

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.

Mainstreet Health Investments to expand senior care presence with $425M deal

Healthcare real estate company Mainstreet Health Investments has signed a definitive agreement to acquire Care Investment Trust and its dozens of senior care and skilled nursing facilities in 11 states, with the expanded company rebranding to become Invesque.

CMS cancels Shared Decision Making ACO model

Too few accountable care organizations (ACOs) were interested in testing CMS’s Shared Decision Making (SDM) model, so the agency announced it wouldn’t be moving forward with the program.

What’s a hospital without patients? A St. Louis facility is finding out

The buzzwords related to information technology and advanced communication are familiar—digital, virtual, real-time, eHealth, telemedicine. But sometimes they can be used in a way that’s a bit confusing. For example, a facility outside St. Louis is perhaps the world’s most advanced virtual hospital. But the building is real, the doctors are real, the nurses making rounds are real. It’s just the patients that are missing.

More states join AMA diabetes prevention program

The American Medical Association (AMA) announced it will expand its effort to prevent Type 2 diabetes to eight additional states after it was launched last year in California, Michigan and South Carolina.

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