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Care Delivery

 

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.

Some 11.8 million people signed up for coverage through the Affordable Care Act (ACA)’s insurance exchanges for 2018, down from 12.2 million the year before. Considering changes that were expected to depress enrollment—like HHS shortening the open enrollment period for Healthcare.gov and cutting its advertising budget by 90 percent—signups “remained generally stable,” according to a report from the National Academy for State Health Policy (NASHP).

In 2011, as outlined in the Affordable Care Act (ACA), Medicare began offering wellness visits at no cost to fee-for-service beneficiaries. The goal of the annual checkup was to introduce preventative care and address specific risks such as depression and risk of falling.

 

Recent Headlines

Benefits targeted by ACA repeal bills aren’t biggest drivers of cost

States would be able to waive requirements for insurers to cover the Affordable Care Act (ACA)’s “essential health benefits” (EHBs) under Republican plans to replace the law. The benefits most likely to be waived, however, make up small shares of premiums compared to other costs, according to an analysis from Urban Institute fellows Linda Blumberg, PhD, and John Holahan, PhD.

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.

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