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Care Delivery

 

UnitedHealth Group has announced plans to expand its work with physicians, health systems and CMS in working with bundled payments in fee-for-service Medicare, including the new Bundled Payments for Care Improvement Advanced program.

Trained community or lay health workers (LHW) helped a rural hospital in Kentucky lowered its 30-day readmission rates among a high-risk population by almost 48 percent, according to a study published in Health Education Research.

Anthem has been criticized and even sued over policies in several states where it won’t pay for emergency room visits it later determines to be unnecessary. The insurer has now softened those restrictions, but American College of Emergency Physicians (ACEP) said the changes don’t go far enough.

Purdue Pharma, best known for making and selling OxyContin, announced Feb. 10 that it will stop marketing opioid drugs to physicians. The company also stated it will lay off half of its sales force, with the remaining staff of 200 focusing on other medications.

Medicaid patients face a host of challenges in accessing care, with reliable, timely transportation often being a major consideration. A recently published study, though, showed rates of missed primary care appointments were unaffected when Medicaid patients were offered free ridesharing services.

 

Recent Headlines

Come together: 5 things to know about forming a virtual group in MIPS

The second year of the Merit-based Incentive Payment System (MIPS) has proposed new option for participation, with clinicians able to join together in “virtual groups” to report on MIPS performance measures.

Millennials will dominate nursing profession by 2020

The average millennial—someone born between 1982 and 2000—is nearly twice as likely to become a registered nurse (RN) than a baby boomer, a “surprising surge of interest” potentially averting a large national shortage of nurses.

Freestanding ERs clustered in wealthier areas

In 2016, there were more than 200 freestanding emergency departments (EDs) in Texas, the center of a boom in these sites of care. With far fewer restrictions on where they can be built compared to hospital-based EDs, most of these facilities have been built in areas where residents have higher household incomes.

AHRQ: Nearly 70% of hospitals are in health systems

The 626 health systems in the U.S. accounted for the majority of hospitals, beds and discharges in 2016, according to data released by the Agency for Healthcare Research and Quality (AHRQ).

Wellness programs, new sites of care common among larger employers’ insurance plans

Group market insurance plans had premiums increase by an average of 3 percent this year, the sixth consecutive year of a single-digit hike and well below the 20 percent jump in non-group market premiums, while employers continue to search for ways to cut costs through different sites of care and wellness programs.

Anthem will re-enter Virginia ACA markets, covering 63 bare counties

Just a month earlier, Anthem had announced it wouldn’t offer ACA exchange coverage in the state, blaming “continued uncertainty” surrounding the law.

ACA’s ‘bare’ county problem is back

Sixty-three cities and counties and more than 70,000 enrollees in Virginia are now at risk of having no insurer participating in their Affordable Care Act (ACA) exchange for 2018, a problem which had appeared to be solved in other parts of the country just two weeks prior.

Construction begins on $270M Texas Health, UT Southwestern campus

Ground has been broken on a $270 million medical campus in Frisco, Texas, that will be jointly operated by Texas Health Resources and the University of Texas Southwestern Medical Center.

Uninsured rate rising in states that didn't expand Medicaid

In the first three months of this year, 8.8 percent of the U.S. population lacked health insurance, a slight decrease from the final 2016 numbers as the big gains in coverage from the Affordable Care Act appear to have ended.

All of US now has at least 1 ACA insurer for 2018

The last county at risk of having no insurers offering plans on the Affordable Care Act (ACA) exchange now has coverage, with CareSource stepping in to sell plans in Paulding County, Ohio.

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