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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

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.

Long-term uninsured made up most of ACA’s initial coverage gains

People who had gone three years or more without having health insurance made up more than half of the gains in coverage in 2014, the first year of the Affordable Care Act (ACA)’s insurance marketplace and Medicaid expansion. 

Half of ICU patients didn’t need intensive care in single-center study

More than half of intensive-care unit (ICU) patients (53 percent) at one large teaching hospital would have received more appropriate care in a different, less intensive setting. 

WellCare acquires Arizona health plans, names new leadership

Medical insurance company WellCare Health Plans has acquired two Arizona health plans and named a new executive to oversee the transition.

Pennsylvania medical college integrates with Geisinger Health System

The new year has brought the final approvals to legally integrate Pennsylvania’s Commonwealth Medical College into Geisinger Health System, creating the new Geisinger Commonwealth School of Medicine.

Healthcare.gov sign-up deadline pushed back

HHS pushed back the deadline for customers to buy coverage on the Affordable Care Act (ACA)'s federally run insurance exchange, giving buyers until Dec. 19 to pick a health plan which will go into effect in the new year.

New ACO model for dual-eligible beneficiaries announced by CMS

CMS has announced the creation of the Medicare-Medicaid Accountable Care Organization (ACO) model, aiming to improve care coordination for beneficiaries who are enrolled in both programs.

Mississippi ranked last in annual state health report

High levels of smoking and poverty contributed to Mississippi being ranked 50th in the 2016 edition of America’s Health Rankings from the United Health Foundation, which also identified some national trends which could reverse recent gains made in other categories of health.

ACA exchange sign-ups outpacing last year

The number of enrollees in plans offered on health insurance exchanges has increased slightly compared to the last open enrollment period, with sign-ups accelerating before the deadline to get coverage starting Jan. 1, 2017.

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