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Care Delivery

 

Anthem has been criticized and even sued over policies in several states where it won’t pay for emergency room visits it later determines to be unnecessary. The insurer has now softened those restrictions, but American College of Emergency Physicians (ACEP) said the changes don’t go far enough.

Purdue Pharma, best known for making and selling OxyContin, announced Feb. 10 that it will stop marketing opioid drugs to physicians. The company also stated it will lay off half of its sales force, with the remaining staff of 200 focusing on other medications.

Medicaid patients face a host of challenges in accessing care, with reliable, timely transportation often being a major consideration. A recently published study, though, showed rates of missed primary care appointments were unaffected when Medicaid patients were offered free ridesharing services.

Some 11.8 million people signed up for coverage through the Affordable Care Act (ACA)’s insurance exchanges for 2018, down from 12.2 million the year before. Considering changes that were expected to depress enrollment—like HHS shortening the open enrollment period for Healthcare.gov and cutting its advertising budget by 90 percent—signups “remained generally stable,” according to a report from the National Academy for State Health Policy (NASHP).

In 2011, as outlined in the Affordable Care Act (ACA), Medicare began offering wellness visits at no cost to fee-for-service beneficiaries. The goal of the annual checkup was to introduce preventative care and address specific risks such as depression and risk of falling.

 

Recent Headlines

1 in 5 older patients felt discriminated against by doctors, hospitals

Racial discrimination was by far the most common reason cited by black patients for receiving poor service or treatment from physicians or hospitals, according to a study published in the Journal of General Internal Medicine. White and Hispanic patients, however, also reported “high rates of discrimination” for other reasons such as age, weight or income.

Unnecessary medical spending doesn’t decrease with high-deductible plans

High-deductible health plans have been framed as a way to give healthcare consumers more “skin in the game,” leading them to avoid low-value services as a way to save money. According to researchers from the USC Schaeffer Center for Health Policy and Economics and the RAND Corporation, they’re having little to no impact.

5 top issues for the healthcare industry in 2018

PricewaterhouseCoopers' (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.

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