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Care Delivery

 

Providers and payors want to work together on transitioning to value-based care. What gets in the way is poor communication and time wasted on redundant administrative tasks, according to a Availity survey released at the Healthcare Financial Management Association (HFMA) conference in Orlando.

The University of Utah’s Huntsman Cancer Institute (HCI) has opened a 225,00-square-foot expansion which it said doubles its laboratory space for cancer research.

States that expanded Medicaid eligibility saw emergency department (ED) use per 1,000 people increase by 2.5 visits in 2014, with the share of ED visits covered by Medicaid increasing by 8.8 percentage points compared to states that didn’t expand the program under the Affordable Care Act.

Value-based care models have led accountable care organizations to change how they utilize their workforce through interdisciplinary teams and managing care by focusing on the highest-risk, and highest-cost, patients.

Health systems have appeared eager to partner with medical schools on preparing medical school students for the value-based care world in which they’ll be practicing, though some educators are worried about being lost in that transition.

 

Recent Headlines

Need for real-world evidence in value-based care could be advantage for pharma

With more physicians employed in larger organizations than private practices, and those larger groups being more likely to be reimbursed through models which involve financial risk, more physicians are looking to real-world evidence to inform their clinical decisions—a shift which could be beneficial for pharmaceutical companies.

New Jersey law limits initial opioid prescriptions to five days

New Jersey has enacted what its governor calls the strictest anti-opioid law in the country, affecting how long the length of initial prescriptions and waiving prior authorization requirements for those seeking treatment for addiction.

Uninsured rate at 8.8 percent; high-deductible plans on the rise

The latest National Health Interview Survey figures on health coverage show the number of people without health insurance fell to a new low through the first nine months of 2016.

California insurers reported inaccurate provider info to regulators

According to a review released by the California Department of Managed Health Care (DMHC), 90 percent of California insurer reports on which providers were in their network contained inaccurate information.

Lower wages change utilization, even in employer-sponsored insurance plans

Workers who make $24,000 or less annually, but still have employer-sponsored health insurance, have higher hospital and emergency department admissions rates and lower utilization of preventive care compared to higher-paid coworkers.

Physicians warn Trump immigration order will worsen doctor shortage, affect care

Two University of Pennsylvania Medical Center physicians said suspending immigration from seven Muslim-majority countries will have a negative impact on graduate medical education (GME) and the U.S. healthcare system as a whole.

Major organizations aim to change prior authorization requirements

A coalition of medical organizations led by the American Medical Association has released a 21-point plan to change when health insurers require pre-approval before patients can receive certain treatments, drugs or devices.

Illinois governor proposing new pharmacy rules after risky drug combinations go unnoticed

In response to a Chicago Tribune investigation, Illinois Gov. Bruce Rauner is a backing of series of changes to the state’s oversight of pharmacies, including sending “mystery shoppers” to make sure pharmacists are warning customers when their prescriptions may have adverse effects when taken together. 

Anthem ending opioid treatment preauthorization nationwide

Anthem has reached a settlement with New York Attorney General Eric Schneiderman to end its policy requiring prior authorization for medication-assisted treatment (MAT) for opioid addiction.

CMS: 45% of provider locations in Medicare Advantage directories are inaccurate

A CMS review of provider directories set up by Medicare Advantage plans found many listed the wrong phone numbers or locations for physicians or incorrectly labeled physicians as accepting new patients.

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