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Care Delivery

 

High-deductible health plans have been framed as a way to give healthcare consumers more “skin in the game,” leading them to avoid low-value services as a way to save money. According to researchers from the USC Schaeffer Center for Health Policy and Economics and the RAND Corporation, they’re having little to no impact.

PricewaterhouseCoopers' (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.

 

Recent Headlines

Value-based care doesn’t have to end independent practices

The transition to value-based care has led to consolidation and increased physician employment, but smaller practices may find a different option in pursuing alignments with other organizations which don’t involve giving up their independent status.

Tufts Medical Center nurses to strike on July 12 over staffing, pension issues

Nurses at Tufts Medical Center in Boston are planning to go on a one-day strike on July 12, while the hospital has hired enough replacement nurses for a five-day lockout.

HFMA 2017: Provider-payor collaboration limited by phone calls, administrative waste

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.

Huntsman Cancer Institute opens new research center

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.

Medicaid expansion increased ER visits overall, but lowered them among uninsured

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.

How ACOs change their workforces to manage risk

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.

AMA 2017: Injecting health systems science into med school curriculums

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.

What health benefits insurers would most likely eliminate under AHCA

Maternity care services may the first thing insurers on the individual market drop from plans if the American Health Care Act (AHCA) becomes law and states seek waivers on what benefits have to be covered.

ACA enrollment fell by nearly 2M by mid-March

A new report from CMS said that effectuated enrollment in the Affordable Care Act (ACA) exchanges was lower than 1.9 million because of customers not paying their premium—with some blaming the monthly cost has the reason for ending their coverage.

40% of adults enrolled in high-deductible insurance plans

A recent survey shows an increasing number of adults were enrolled in health plans with deductibles above $1,300 for individual plans and $2,600 for family coverage in 2016 as more employers turn to plans with higher out-of-pocket costs.

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