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How CMS Undermines Pioneer ACOs and What to do About It
By KIP SULLIVAN In my first post in this three-part series, I documented three problems with Pioneer ACOs: High churn rates among patients and doctors; assignment to ACOs of healthy patients; and assignment of so few ACO patients to each ACO doctor that ACO “attributees” constitute just 5 percent of each doctor’s panel. I noted that these problems could explain why Medicare ACOs have been so ineffective. These problems are the direct result of CMS’s strange method of assigning patients to ACOs. Patients do not decide to enroll in ACOs. CMS assigns patients to ACOs based on a two-step process: (1) CMS first determ...
Source: The Health Care Blog - May 26, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized ACOs CMS HMOs Pioneer ACOs Source Type: blogs

How CMS Undermines ACOs and What to do About It
By KIP SULLIVAN In my first post in this three-part series, I documented three problems with Pioneer ACOs: High churn rates among patients and doctors; assignment to ACOs of healthy patients; and assignment of so few ACO patients to each ACO doctor that ACO “attributees” constitute just 5 percent of each doctor’s panel. I noted that these problems could explain why Medicare ACOs have been so ineffective. These problems are the direct result of CMS’s strange method of assigning patients to ACOs. Patients do not decide to enroll in ACOs. CMS assigns patients to ACOs based on a two-step process: (1) CMS first determ...
Source: The Health Care Blog - May 26, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized ACOs CMS HMOs Pioneer ACOs Source Type: blogs

ACO Turnover is High. Doctors Have Few Patients, and Those Patients are Unusually Healthy
By KIP SULLIVAN, JD ACOs suffer astonishingly high turnover rates among their doctors and patients; their patients are unusually healthy; and those unusually healthy ACO patients constitute about 5 percent of each ACO doctor’s panel of patients. These facts appear in three recent reports: CMS’s final evaluation of the Pioneer ACO program, and two papers published in Health Affairs by John Hsu et al. Each of these facts – high turnover, healthier patients, and few ACO patients in each physician’s panel – poses problems that cannot be solved without a substantial redefinition of the ACO. How are doctors supposed to...
Source: The Health Care Blog - May 22, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized ACOs Health Affairs John Hsu Sullivan Source Type: blogs

Insurers, Marketplaces Face Uncertainty As Parties Seek Further House v. Price Delay
On May 22, 2017, the House of Representatives and the Department of Justice jointly asked the District of Columbia Court of Appeals to continue to hold House v. Price in abeyance, presumably for another 90 days as contemplated by the court’s earlier order. The next status report would be due on August 20, 2017. The court is expected to respond to their request in the near future. Legal Background As readers of this Blog know, this case was known earlier as House v. Burwell. The Affordable Care Act (ACA) requires insurers to reduce out-of-pocket limits and other cost sharing for enrollees in marketplace silver plans with ...
Source: Health Affairs Blog - May 22, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage cost-sharing reductions House v. Burwell house v. price Source Type: blogs

Health Wonk Review Archives: 2006-2016
July 21, 2017 - Steve Anderson - medicareresources.org June 23, 2017 - Joe Paduda - Managed Care Matters June 1, 2017 - Andrew Sprung - xpostfactoid May 18, 2017 - Jason Shafrin - Healthcare Economist May 4, 2017 - Julie Ferguson - Workers Comp Insider April 20, 2017 - Brad Wright - Wright on Health April 6, 2017 - Hank Stern - InsureBlog March 23, 2017 - Louise Norris - Colorado Health Insurance Insider March 9, 2017 - Peggy Salvatore - Health System Ed Blog February 23, 2017 - David Williams - Health Business Blog February 9, 2017 - Steve Anderson - medicareresources.org January 26, 2017 - Joe Paduda at Mana...
Source: Health Wonk Review - May 20, 2017 Category: Health Management Source Type: blogs

Preserving The Bipartisan Commitment To Health Care Delivery System Reform
Editor’s Note: This is the first in a five-part Health Affairs Blog series, produced in conjunction with the Bipartisan Policy Center, examining current issues and care models in the delivery system reform effort. Each post will be jointly authored by Democratic and Republican leaders in health policy. Check back for the next entry in the series on May 25. Improving and reforming our health care delivery system is not a partisan issue. The need to improve health care delivery models, as a means for ensuring better patient outcomes and a more efficient health care system, enjoys broader consensus than elements surrounding...
Source: Health Affairs Blog - May 18, 2017 Category: Health Management Authors: Alice M. Rivlin and Sheila Burke Tags: Featured Health Professionals Hospitals Medicare Organization and Delivery Payment Policy bipartisan delivery system reform Bipartisan Policy Center delivery reform value based care Source Type: blogs

Why Greenhouse Nursing Homes are Rising in Popularity
Conclusion The Greenhouse Project is aiming to put a different spin on traditional assisted living for seniors. This alternative option has been good for many elders in need of care who are seeking something different than a common nursing facility. Do you have a loved one who has lived or is currently residing in a Greenhouse Project facility? We encourage you to share below in the comments section! (Source: Shield My Senior)
Source: Shield My Senior - May 17, 2017 Category: Geriatrics Authors: Stevie Compango Tags: Senior Safety Source Type: blogs

Medicaid: What Happens Now?
With public attention completely focused on the wild effort to reach closure on the private health insurance provisions of the American Health Care Act (AHCA) (H.R. 1628), it was easy to overlook (at least for a moment) the extraordinary nature of its Medicaid changes. Were these provisions to become law, the AHCA would represent the most sweeping federal policy shift since the program’s 1965 enactment. How The AHCA Would Affect Medicaid The AHCA would end the Affordable Care Act’s enhanced funding for the adult expansion population. More profoundly, however—and completely disconnected from the AHCA’s “repeal...
Source: Health Affairs Blog - May 17, 2017 Category: Health Management Authors: Sara Rosenbaum Tags: Costs and Spending Featured Following the ACA Insurance and Coverage Medicaid and CHIP Quality ACA repeal and replace AHCA EPSDT Medicaid block grants Medicaid expansion Medicaid per capita cap medicaid work requirement Source Type: blogs

Taxing Drug Price Spikes: Assessing The Potential Impact
On March 29, 2017, senior Democrats introduced comprehensive legislation (titled the Improving Access to Affordable Prescription Drugs Act) in the House and Senate aimed at lowering prescription drug costs and improving transparency. The 129-page bill contains several popular provisions that could help drive its passage or could reappear in a future bipartisan attempt to repair or replace the Affordable Care Act. One such provision is section 202, which establishes an excise tax on drugs with price increases exceeding the inflation rate. The amount of the tax penalty would depend on the size of the price increase. It is mo...
Source: Health Affairs Blog - May 12, 2017 Category: Health Management Authors: Thomas Hwang and Aaron Kesselheim Tags: Costs and Spending Drugs and Medical Innovation Insurance and Coverage Medicaid and CHIP Medicare Payment Policy Association of the British Pharmaceutical Industry drug price spikes excise tax on drugs Improving Access to Affordable Pres Source Type: blogs

The ‘ Medicaidization ’ Of The Health Insurance Marketplaces: A Necessary Trend
When stripped of emotion and hyperbole, the debate about repealing and replacing the Affordable Care Act (ACA) is fundamentally about how to stretch limited funds to offer health care to two populations in need: the poor, who receive health care through Medicaid, and the “near-poor,” who were frequently without coverage prior to the ACA’s enactment. While millions of the near-poor remain uninsured today, six out of 10 limited-income individuals who purchased health care through the ACA’s health insurance Marketplaces were uninsured prior to the ACA. It is this near-poor and recently insured population, and how to c...
Source: Health Affairs Blog - May 8, 2017 Category: Health Management Authors: Margaret Murray and Mike Adelberg Tags: Costs and Spending Following the ACA Insurance and Coverage Medicaid and CHIP Payment Policy ACA Marketplaces ACA repeal and replace narrow networks risk pools Social Determinants of Health utilization management Source Type: blogs

Health Wonk Review - upcoming hosts
May 18, 2017 - Jason Shafrin - Healthcare Economist June 1, 2017 - Andrew Sprung - xpostfactoid June 15, 2017 - Joe Paduda - Managed Care Matters (Source: Health Wonk Review)
Source: Health Wonk Review - May 4, 2017 Category: Health Management Source Type: blogs

The Future Of Delivery System Reform
Over the past several years, the federal government has put billions of dollars into a variety of programs aimed at improving the way health care is delivered. The Affordable Care Act (ACA) authorized a broad agenda of reform projects, including accountable care organizations (ACOs), bundled payments, value-based purchasing, primary care initiatives, and other payment and service delivery models. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 established new ways of paying physicians intended to promote high-quality patient care. What will happen to these initiatives under a Congress where Republicans are...
Source: Health Affairs Blog - April 20, 2017 Category: Health Management Authors: Joseph Antos and James Capretta Tags: Costs and Spending Insurance and Coverage Medicare Payment Policy Accountable Care Organizations ACOs Affordable Care Act HMOs MACRA Medicare Advantage supplemental insurance reform Source Type: blogs

MACRA Is Broken. It Needs to Go Away Now.
By KIP SULLIVAN At its January 12, 2017 meeting, the Medicare Payment Advisory Commission (MedPAC) made it clear they had reached the conclusion that the Merit-based Incentive Payment System (MIPS) cannot work (see my last post ). MIPS is the larger of the two programs within MACRA; the Alternative Payment Model (APM) program is the other. The commission’s primary rationale for its conclusion about MIPS is that it’s not possible to measure physician “merit” (cost and quality) at the individual physician level. But rather than recommend that Congress repeal MACRA (the Medicare Access and CHIP Reauthorization Act), ...
Source: The Health Care Blog - April 15, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Alternate Payment Model APM MACRA MIPS Source Type: blogs

Measuring MACRA
By STEVEN FINDLAY With all the machinations over ACA repeal and replace, the new law that makes big changes in the way the federal government pays doctors—the Medicare Access and CHIP Reauthorization Act, or MACRA—hasn’t garnered much attention lately. But doctors nationwide are sure thinking about it. That includes many of the regular commentators on THCB. I think it’s accurate to say that most of them have been highly critical of MACRA since the law was enacted in April 2015, and even after it was significantly amended late last year to address physician complaints. (See, for example, Kip Sullivan’s most recent...
Source: The Health Care Blog - April 15, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized MACRA MIPS Steven Findlay Source Type: blogs