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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

Hospitals, doctors shifting to coordinated care and assuming more risk

More consolidation among hospitals and providers is expected in the next few years.

Population health management becoming more common

Today, there are more than 400 Medicare accountable care organizations and nearly 300 private ACOs.

Navigator program improves outcomes in high-risk population

A health navigator pilot program in Memphis, Tennessee shows promising results.

Senators introduce bill to change readmissions program

A bipartisan group of U.S. Senators introduced a bill to revamp the readmissions program created as part of the Patient Protection and Affordable Care Act and help hospitals that serve low-income patients.

CMS introduces new ACO model for payment and care delivery reform

The Centers for Medicare & Medicaid Services announced an updated model of accountable care organization that focuses on new payment and care delivery models.

What hospitals are top performers? Depends on which ratings system you ask

Patients want to visit a highly rated hospital. Providers want to maintain a high level of quality. Payers are looking to incentivize high-value care.

Alzheimer’s disease portal contains vast amounts of data

The National Institutes of Health has introduced a portal that includes Alzheimer’s disease data that researchers can share and analyze to help them design clinical trials and evaluate therapeutic targets.

Swing-bed utilization at critical access hospitals increasing

From 2005 through 2010, swing-bed utilization and Medicare spending at critical access hospitals increased significantly, according to an analysis from the Office of Inspector General of the Department of Health and Human Services.

States prepare for healthcare delivery system changes

Through a Centers for Medicare & Medicaid Service initiative, states are encouraged to revamp their healthcare delivery systems and improve their care while lowering costs.

Hospital and physician office visits increase thanks to the Affordable Care Act

When the Patient Protection and Affordable Care Act is fully implemented, hospital outpatient departments will see a 2.6 percent increase in visits and primary care providers will see a 3.8 percent increase in visits, according to a new Commonwealth Fund analysis.

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