Medicaid Buy-In: A sensible approach for coverage and cost
Show me the coverage!
The term ‘Medicare for All’ is being bandied about as the campaign for the Democratic Presidential nomination gets underway. Declared and potential candidates are warming to the idea.
It’s easy to see why:
After years of trying to defend complex, compromised Obamacare from GOP rhetorical attacks and legislative and administrative undermining, Democrats are going with a program that is popular and well funded
Medicare especially appeals to the middle-aged and older population, who tend to vote. There’s no stigma attached to it
It could be funded and implemented as a sweeping pr...
Source: Health Business Blog - January 23, 2019 Category: Health Management Authors: dewe67 Tags: Health plans Policy and politics Medicaid medicaid buy-in medicare medicare for all presidential election Source Type: blogs
Improving Healthcare Efficiency with Incentives: Interview with Ben Kraus, CEO of Stellar Health
We present simple reminders to the provider at the point-of-care. For example: “There are two things that you really need to do for this patient today, based on their history.” It simplifies everything and prioritizes the actions that contribute to a healthier patient in the long-run. Trying to use an EHR to do this doesn’t work because EHRs were designed to serve as a complete clinical record of a patient, which is cavernous and lacks actionability. EHRs were not designed to align payor and providers incentives and create a prioritization framework to maximize health outcomes.
There are innovative companies out th...
Source: Medgadget - January 23, 2019 Category: Medical Devices Authors: Mohammad Saleh Tags: Exclusive Informatics Medicine Public Health Society Source Type: blogs
Let ’s Jettison The Consumer Directed Health Plan (CDHP) Foolishness And Split Savings With Patients
By the early 2000s, both employers and health plans were beginning to realize that managed-care jig was up. Managed-care organizations have seemingly wrung much of the obvious waste out of the healthcare delivery system, and measures designed to further tighten the noose — such as requiring that patients pass all care requests through gatekeepers — […] (Source: EMR and HIPAA)
Source: EMR and HIPAA - January 18, 2019 Category: Information Technology Authors: Anne Zieger Tags: Administration Ambulatory C-Suite Leadership EMR-EHR Healthcare IT Hospital - Health System Revenue Cycle Management CDHPs Consumer-Driven Health Plans Consumerism Harvard Business School HDHPs Healthcare Consumerism High-Deducti Source Type: blogs
Hospitals Hike Ad Spending After Data Breaches
Few would argue that hospitals suffer a hit to their reputation whenever they suffer a well-publicized data breach. Apparently, one of their key methods for re-establishing their brand is to hike up their advertising expenditures, a new research study has concluded. The study, which appears in The American Journal of Managed Care this month, examines […] (Source: EMR and HIPAA)
Source: EMR and HIPAA - January 17, 2019 Category: Information Technology Authors: Anne Zieger Tags: C-Suite Leadership Healthcare IT Hospital - Health System Org Type Role Security and Privacy Topic Hospital Advertising Hospital Data Breach Hospital Data Breach Costs Hospital Data Security Source Type: blogs
The old days of medicine are gone
In the last decade, specifically in the last five to six years, we have seen the gradual disempowerment of America ’s physicians as well as their unfortunate patients. Starting with health management organizations, managed care, all the way to the insurance exchange, doctoring has been forcefully wrestled away from physicians only to be placed into the […]Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - January 17, 2019 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/michael-weiss" rel="tag" > Michael Weiss, MD < /a > < /span > Tags: Physician Practice Management Primary Care Source Type: blogs
New Study: Medicare ’s Readmission Penalties May Be Killing Patients
By KIP SULLIVAN JD
On the morning of December 21, I opened my copy of the New York Times to find an op-ed that said almost exactly what I had said in a two-part article The Health Care Blog posted two weeks earlier. The op-ed criticized the Hospital Readmissions Reduction Program (HRRP), one of dozens of “value-based payment” programs imposed on the Medicare fee-for-service program by the Affordable Care Act. The HRRP punishes hospitals if their rate of readmissions within 30 days following discharge exceeds the national average. The subtitle of the op-ed was, “A well-intentioned program created by the Affordable ...
Source: The Health Care Blog - January 8, 2019 Category: Consumer Health News Authors: matthew holt Tags: Medicare Politics CMS Congress Hospital Readmissions Reduction Program Kip Sullivan MedPAC value-based care Source Type: blogs
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Regulations in place since 2016 that allowed state Medicaid programs flexibility to use managed care contracting and payments to drive reform in how health care is delivered and paid for are likely to remain largely intact. However, certain provisions will weaken standards designed to ensure a sufficient network of health providers is available to serve enrollees.
(Source: The Commonwealth Fund: Blog)
Source: The Commonwealth Fund: Blog - January 5, 2019 Category: International Medicine & Public Health Authors: Cindy Mann, Hailey E. Davis Source Type: blogs
Is CareMore Health ’ s Population Health Management Model Disruptive?
By REBECCA FOGG
Fueled by Americans’ urgent need for better chronic disease care and insurers’ march from fee-for-service to value-based payments, innovation in population health management is accelerating across the health care industry. But it’s hardly new, and CareMore Health, a recent acquisition of publicly-traded insurer Anthem, has been on the vanguard of the trend for over twenty years.
CareMore Health provides coordinated, interdisciplinary care to high-need patients referred by primary care physicians in nine states and Washington, D.C. The care encompasses individualized prevention and chronic disease ma...
Source: The Health Care Blog - December 27, 2018 Category: Consumer Health News Authors: matthew holt Tags: Medicaid Medicare Patients CareMore Health disruptive innovation Healthcare innovation Population Health Rebecca Fogg Source Type: blogs
How religious exemptions will affect Medicaid managed care
In the United States, 25 million adult women are insured by their state Medicaid program. Medicaid covers 60 percent of all births in the United States as per federal law, and states must cover all pregnancy-related services for pregnant women with incomes up to 133 percent of the federal poverty line. There are two Medicaid […]Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - December 27, 2018 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/ishaan-shah" rel="tag" > Ishaan Shah < /a > < /span > Tags: Policy Public Health & Source Type: blogs
CMS Should Boost the Signal on Social Determinants of Health
By HERB KUHN
Historically, the Centers for Medicare & Medicaid Services’ (CMS) stance on the influence that social determinants of health (SDOH) have on health outcomes has been equal parts signal and noise. In April 2016, the agency announced it would begin adjusting the Medicare Advantage star ratings for dual-eligibility and other social factors. This was amid calls for increased equity in the performance determinations from the managed care industry. At the same time, CMS continued to refuse risk-adjustment for SDOH in the Hospital Readmissions Reduction Program (HRRP) despite the research supporting the influe...
Source: The Health Care Blog - December 21, 2018 Category: Consumer Health News Authors: matthew holt Tags: Health Policy Hospitals CMS Herb Kuhn HRRP Social Determinants of Health Source Type: blogs
Increased Payer and Provider Support May Drive Billions of Dollars in Savings from Biosimilars
By SHEILA FRAME
FDA Commissioner Scott Gottlieb has said biosimilars are “key to promoting access and reducing health care costs. And it’s a key to advancing public health.” While the Administration works to reduce barriers to bringing biosimilars to market, payers and providers can help increase adoption of biosimilars in clinical practice and ensure cost savings.
Organizations such as the American College of Rheumatology and the American Society of Clinical Oncology have issued educational documents to help guide providers in incorporating biosimilars into treatment plans, where appropriate. Yet, many doctors re...
Source: The Health Care Blog - December 20, 2018 Category: Consumer Health News Authors: matthew holt Tags: Pharmaceuticals biologics biosimilars Sheila Frame Source Type: blogs
Medicaid Expansion is Evidence the Health Policy Debate Defies Political Divides
By AMY LONG and JOE MOLLOY
Among all the talk of waves and tides of the close midterm races around the country, there were tremendous results on election day for Medicaid expansion. Three states – Idaho, Nebraska, and Utah – passed ballot initiatives approving the policy.
On top of that, in Kansas and Maine, governors who had vetoed the policy in the past were replaced with candidates promising to enact it.
This was obviously great news for supporters of Medicaid expansion with the total number of expansion states firmly at 36.
What were the issues?
In Idaho, the Expansion ballot initiative was designed to provide in...
Source: The Health Care Blog - December 12, 2018 Category: Consumer Health News Authors: matthew holt Tags: Health Policy Medicaid Politics Amy Long Joe Molloy Medicaid Expansion Midterm Elections Toothpic Source Type: blogs
Is there an ROI on AI?
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Source: HealthBlawg :: David Harlow's Health Care Law Blog - November 15, 2018 Category: Medical Law Authors: David Harlow David Harlow Tags: Artificial Intelligence Big Data FDA Health care policy Health Insurance Health Law Healthcare Innovation HIT Internet of Things Machine Learning Managed Care Medical Devices Source Type: blogs
