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Care Delivery


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.


Recent Headlines

ANA: U.S. will need 1.1 million more R.N.s by 2022 to head off shortage

The American Nurses Association (ANA) is urging immediate increased investment in nursing training to ensure a sufficient nursing workforce to meet anticipated future demand from an aging U.S. population and the newly insured under the Affordable Care Act’s coverage expansions.

Delaware hospital’s bedside addiction intervention program gets White House officials’ attention

One hospital’s program that puts peer counselors at the bedside of patients with addiction and substance abuse problems has earned it an invitation to the White House. Leaders from Christiana Care Health System in Wilmington, Delaware, were asked to present their early addiction intervention program, Project Engage, to officials from the White House Office of National Drug Control Policy.

Ohio hospitals show cutting HAIs requires cultural shift

Reducing hospital acquired infections significantly is possibly simply through better adherence to hand washing standards by clinical staff. However, making a hand-washing initiative stick is difficult because people naturally tend to become less adherent to standards over time without a culture that positively reinforces the standard, according to experts from Ohio’s MetroHealth Medical Center, University Hospitals and the Cleveland Clinic.

16 challenges in healthcare payment reform

The Bipartisan Policy Center (BPC) has issued a new report that seeks to identify the specific challenges and opportunities the U.S. Department of Health and Human Services faces in implementing healthcare reform. Notably, many of the problems identified in the report are the same as those pointed out by healthcare industry executives and the organizations that represent them.

Alliance with North Shore-LIJ lets Cleveland Clinics’ cardiovascular care program reach sizeable New York market

The Cleveland Clinic Heart & Vascular Institute is expanding its reach to include the New York metropolitan area, home to nearly 20 million people, through a unique alliance with the North Shore-LIJ Health System, which has 17 hospitals and more than 400 outpatient physician practices in the New York region.

Missouri to let medical students work as assistant physicians

Missouri Governor Jay Nixon has signed into a law a bill that makes it legal for medical students who have not yet completed a year of residency to work as “assistant physicians” within the state, delivering primary care services with 10 percent of their work reviewed by a physician.

HHS launches new initiative to help states reform Medicaid payment and delivery systems

Responding to recent recommendations made by the National Governors Association’s (NGA) Health Care Sustainability Task Force, the U.S. Department of Health and Human Services (HHS) is launching what it calls “a new innovative collaboration with states to improve care for Medicaid beneficiaries by accelerating efforts in reforming their health care systems to improve health and care while reducing costs.” 

New York provider consortium takes aim at Medicaid costs, and state grant money

More than 200 community-based organizations that provide various health services across the 14-county area around Rochester, New York, are teaming up to identify ways to reduce the state’s Medicaid costs while improving care quality. Along the way, they also hope to win some of the state’s Delivery System Reform Incentive Payment program, or DSRIP, $8-billion waiver from the Centers for Medicare and Medicaid Services.

Detroit Medical Center wins +$9 million HHS Innovation Award to test putting primary care adjacent to ED

Detroit Medical Center and Vanguard Health have won a $9,966,608 Department of Health an Human Services (HHS) Health Care Innovation Award to test what might happen to emergency department utilization if patient-centered medical home clinics are established next to four major inner-city emergency departments (EDs) and used to make primary care immediately available to individuals who arrive at the EDs for non-urgent care.

New government funding tackles primary care shortage

The Department of Health and Human Services (HHS) announced this week that it will put nearly $200 million toward community health center expansion funding and primary care physician training, as well as funding new health innovation projects that address primary care. But it is unlikely to make a sizeable dent in the primary care shortage, notes the grassroots advocacy group Primary Care Progress.