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Care Delivery

 

The number of counties at risk of having no insurer on their Affordable Care Act (ACA) exchange has fallen to just two, with Centene stepping in to cover potentially bare counties in Nevada.

The idea of a national, single-payer healthcare system is as divisive as ever to people within the industry, according to a new survey from cloud-based researcher company Reaction Data.

When asked to identify what regulations are the most burdensome, physician practices pointed at the Merit-based Incentive Payment System (MIPS) being implemented as part of the Medicare Access and CHIP Reauthorization Act (MACRA).

Insurance giant Anthem continued its departure from Affordable Care Act (ACA) exchanges, announcing it will no longer offer plans in Nevada and 74 counties in Georgia.

CMS has approved a five-year extension of Florida’s statewide Medicaid managed care demonstration, including $1.5 billion in funding for support uncompensated care for low-income patients.

 

Recent Headlines

Study finds disjointed care patterns in current Medicare ACO model

Holding organizations accountable for care utilization and outcomes while simultaneously allowing Medicare beneficiaries free access to any provider they want either inside or outside an Accountable Care Organization (ACO) is a problem, say critics of the government’s current ACO program. A new study published by JAMA Internal Medicine finds these critics may be right.

AHA warns that Pioneer ACO program is in danger unless changes are made

Few additional providers will sign up to participate in Medicare’s current Pioneer ACO Model or the Medicare Shared Savings Program unless changes are made to the design of these programs notes the American Hospital Association (AHA) in a letter to the Centers for Medicare and Medicaid Services (CMS) Innovation Center.

Insurer and healthcare provider form unique care coordination joint venture

Insurer Independence Blue Cross (Independence) and integrated care management company DaVita HealthCare Partners have jointly formed a new company, Tandigm Health, to deliver high-quality care at a lower cost in the Philadelphia area, a region with some of the highest healthcare costs in the nation.

Defying expectations, greater insurance coverage is linked to increased ED use

The hope that universal health insurance coverage will move healthcare delivery out of costly care settings like emergency departments (EDs) and into lower-cost primary care settings may not come true unless other barriers to primary care access also are addressed finds a new study.

CareMore, Emory to tackle reducing costs and improving outcomes in Georgia seniors

WellPoint Inc.’s Cerritos, Calif.-based subsidiary CareMore and Atlanta-based Emory Healthcare say they will team up to expand CareMore’s model of care management for Medicare Advantage patients in Georgia.

Hospital groups launch website to improve perception of consolidation

The American Hospital Association and the Federation of American Hospitals have joined forces on changinglandscape.org, a new website that aims to explain how realignment and consolidation of hospital systems can help communities and patients.

Majority of physician practices not joining ACOs

A national telephone survey finds that 60.6 percent of physician organizations report no current involvement and no plans to become involved in an accountable care organization (ACO) in the near future.

NCQA Updates Medical Home Standards Amidst Criticism for Lack of Focus on Outcomes

The National Committee for Quality Assurance (NCQA) is updating its standards for Patient-Centered Medical Home Recognition, as concern grows that the standards focus too heavily on structural elements of medical homes and not enough on outcomes.

Reducing Unnecessary Readmissions Requires Carrots, Not Just Sticks

Lowering unnecessary hospital readmission rates is an often cited solution to the problem of high U.S. health care costs. However, to effectively do so, the health care system needs to reward all stakeholders for collaborating, not just punish hospitals for unnecessary readmissions, a new report finds.

Wisconsin Hospitals Raise the Quality Bar—Across the Board

Reducing readmissions remains one of the most difficult challenges for hospitals everywhere. Members of the Wisconsin Hospital Association (WHA), however, have been working together to reduce the incidence of hospital readmissions within 30 days of discharge—and their performance runs far ahead of the national average.

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