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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

AAMC: Physician shortage could surpass 100,000 by 2030

The Association of American Medical Colleges (AAMC) said the nation’s physician shortage isn’t going to get any better, projecting a shortage of between 40,800 and 104,900 doctors by 2030 in a report conducted by global information company IHS Markit.

First-year residents will once again be able to work 24-hour shifts

The Accreditation Council for Graduate Medical Education (ACGME) has revised its limits on how long first-year residents can work in a single shift, increasing it from 16 to 24 hours, matching the maximum for residents at all levels.

How delivery system innovations can succeed: ‘Do fewer projects, but do them better’

The need for changing healthcare delivery is clear, according to David Bates, MD, MSc, chief of the general internal medicine division at Brigham and Women’s Hospital in Boston. Allowing those changes to succeed in the world of value-based care, however, may require organizations to devote more of its own resources to delivery system reforms. 

HIMSS 2017: Prior authorization flaws require collaborative response

A multi-stakeholder conversation about the burden of prior authorization requirements offered a consensus that something has to change with these policies, but the parties could not offer a silver bullet on how the process can improve.

Telehealth increases utilization instead of replacing office visits

Using direct-to-consumer telehealth, where a patient was direct access to a physician on the phone or through videoconferencing, may be a tool to increase access to care. According to a study published in the March 2017 issue of Health Affairs, it also increases utilization and spending. 

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.

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