MedPAC Got It Wrong (pt 3)
This report acknowledges the record levels of surpluses. Each of those surpluses represents MA costing less than standard Medicare because they come from the capitation and they are absolutely a better use of the Medicare dollar than fee-for-service Medicare gets from spending that same dollar. Plans have created a record number of surpluses each year and they all come from spending fewer dollars per person than standard Medicare. Fee-for-service Medicare is a very poor purchaser of care — and that fee-for-service Medicare program now has its average member each spending more than $5000 in out of pocket costs each yea...
Source: The Health Care Blog - April 5, 2022 Category: Consumer Health News Authors: matthew holt Tags: Health Policy The Business of Health Care George Halvorson Medicare Advantage MedPAC Source Type: blogs

Oregon is seeking authority to deny Medicaid coverage for certain new, high-cost prescription drugs that have won accelerated approval from the U.S. Food and Drug Administration.        (Source: The Commonwealth Fund: Blog)
Source: The Commonwealth Fund: Blog - April 5, 2022 Category: International Medicine & Public Health Authors: Edwin Park Source Type: blogs

A New Generation of Caregivers: Grandchildren Taking Care of Grandparents
Photo credit: Andrea  Piacquadio Family and household composition have changed a great deal over recent decades. Many of these young caregivers have lived with or been raised by their grandparents. For example, a 2021 report published by Generations United found that more than one in four Americans (26 percent) are living in a household with 3 or more generations. In other instances, a grandchild becomes the primary caregiver because he or she lives nearer to the elder than other family members. Sometimes, it’s simply because a particular grandchild feels close to the grandparent and has the so-called “caregiver ...
Source: Minding Our Elders - April 2, 2022 Category: Geriatrics Authors: Carol Bradley Bursack Source Type: blogs

#HealthTechDeals Episode 18: Huma, Afterlife, Timedoc Health Avive, Antidote Health
Exciting things are a-happening in the Medicaid space! Two new female CEOs are being announced today in City Block Health and in Centene! In this episode of Health Tech Deals, Jess and I discuss new leadership changes in the health tech space, as well as new deals: Huma buys Astra Zeneca Digital; Afterlife raises $22 million; Timedoc Health raises $48.5 million; Avive raises $22 million; Antidote Health raises $22 million. (Source: The Health Care Blog)
Source: The Health Care Blog - March 24, 2022 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Health Tech Health Tech Deals Antidote City Block Health Matthew Holt Timedoc Health Avive Source Type: blogs

Celebrating the 12th Anniversary of the Affordable Care Act in a Pandemic: Where Would We Be Without It?
BY ROSEMARIE DAY When the Affordable Care Act (ACA) was signed into law twelve years ago today, Joe Biden called it “a big f-ing deal.”  Little did he, or anyone else at that time, realize how big of a deal it was. Just ten years later, America was engulfed in a global pandemic, the magnitude of which hadn’t been seen in a century. Two years after that, the numbers are chilling: over 79 million people were infected, at least 878,613 were hospitalized, and 971,968 have died. As bad as these numbers are, things would have been much worse if the ACA hadn’t come to pass. The ACA created an essential safety net t...
Source: The Health Care Blog - March 23, 2022 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Health Policy Obamacare Affordable Care Act covid19 Life In the Affordable Care Act Medicaid Pandemic rosemarie day Source Type: blogs

Hospital Systems: A Framework for Maximizing Social Benefit
Conclusion We do not propose this performance framework as a regulatory guide for state or federal authorities. Rather it is presented as a voluntary alternative for managements and Boards seeking to demonstrate the community benefits created by their institutions.    At their best, large health systems can deliver sophisticated, complex care to their communities. But they can also play a key role with community partners in addressing the social determinants of health, thus reducing per capita health cost. Large multi-billion health systems are here to stay. The conversation about how to enhance the health ...
Source: The Health Care Blog - March 21, 2022 Category: Consumer Health News Authors: matthew holt Tags: Health Policy Hospitals Health Systems Ian Morrison Jeff Goldsmith Source Type: blogs

Where Health Care Value Can Lead
By BRIAN KLEPPER It seems inevitable that, in the near future, an innovative health care organization – Let’s call it The Platform – is going to seize the market opportunity of broader value. It will cobble together the pieces, and demonstrate to organizational purchasers that it consistently delivers better health outcomes at significantly lower cost than previously has been available. To manage risk and drive performance, The Platform will embrace the best healthcare management lessons of the past decades: risk identification through data monitoring and analytics, driving the right care, quality manag...
Source: The Health Care Blog - March 15, 2022 Category: Consumer Health News Authors: matthew holt Tags: Health Policy Health Tech Brian Klepper The Platform value based care Source Type: blogs

When the COVID-19 public health emergency ends, potentially in mid-April, millions of Medicaid beneficiaries could be rapidly disenrolled — a longer transition period would help soften the blows.        (Source: The Commonwealth Fund: Blog)
Source: The Commonwealth Fund: Blog - March 14, 2022 Category: International Medicine & Public Health Authors: Leighton Ku, Erin Brantley Source Type: blogs

Only patients can save U.S. health care
U.S. health care is going to hell in a handbasket, but only as patients can we alter this. Centers for Medicare& Medicaid Services (CMS), hospital administrators and we patients are all guilty of worshiping at the altar of“patient satisfaction.” It’s not that patient satisfaction is necessarily a bad thing. As a patient myself,Read more …Only patients can save U.S. health care originally appeared (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - March 11, 2022 Category: General Medicine Authors: < span itemprop="author" > < a href="" rel="tag" > Drew Remignanti, MD, MPH < /a > < /span > Tags: Physician Emergency Medicine Primary Care Source Type: blogs

Mental Health Care & Medicaid State-of-Play: Circulo Health, Brave Health Execs Weigh-In
By JESS DaMASSA, WTF HEALTH Two experts in mental health care for the Medicaid market stop by to help us get smart on the challenges facing patients and providers alike in this critical area of care. It’s not just the payment model that is different; stigma is different, patients are more racially and culturally diverse than those in commercial plans, support systems vary, and even the normalization of seeking mental health care manifests itself differently when it’s individually-driven as opposed to part of an “employer group.” Anna Lindow, CEO of digital-first mental health startup Brave Health, and Vik Ba...
Source: The Health Care Blog - March 8, 2022 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Health Tech WTF Health Anna Lindow Brave Health Circulo Jess DaMassa Medicaid Vik Bakhru Source Type: blogs

Generic Glucagon for $200, Where's the Savings? Get it for $5...WITH a coupon
In December 2020, the U.S. FDA approved several long-delayed generic versions of traditional mix-and-inject form of glucagon emergency kits. Among them were from Amphastar Pharmaceuticals, Inc. of Rancho Cucamonga, CA which was the very first, followed by another from Fresenius Kabi USA based in Lake Zurich, IL (in suburban Chicago, the parent company is based in Germany)
Source: Scott's Web Log - March 7, 2022 Category: Endocrinology Tags: 2022 FDA generic glucagon Source Type: blogs

Skirting the Law: Medicaid Block Grants and Per-Capita Caps in a Pandemic
Laura D. Hermer (Mitchell Hamline School of Law), Skirting the Law: Medicaid Block Grants and Per-Capita Caps in a Pandemic, St. Louis J. Health L.& Pol ’y (forthcoming 2022): To what extent can an administration abridge Medicaid’s entitlement status by... (Source: HealthLawProf Blog)
Source: HealthLawProf Blog - March 1, 2022 Category: Medical Law Authors: Katharine Van Tassel Source Type: blogs

Randolph Hospital (the old/bankrupt Randolph) vs. Cone Healthcare: " Self-dealing " And Unethical Business Practices. DUH. It's Not Like I Did Not Tell You So.
Before we even get started (and for the record), I was born at Cone Hospital.  For years, I admired it from afar.But that was before . . .Once upon a time, twenty-four years ago this month, the executives running my hometown hospital (Randolph Hospital in Asheboro, North Carolina), fired me ( " without cause " ) . . . two weeks after I answered a terrified LDRP charge nurse ' s call in the middle of the night - to intervene in a neonatal case where the managing Family Practitioner was so " lost " that the nurse feared the baby would die before I could get there.  The FP (who later styled himself to the baby ...
Source: Dr.J's HouseCalls - February 24, 2022 Category: American Health Tags: Asheboro Atrium Health Bankruptcy Bob Morrison Cone Healthcare Ed Cone Medical Whistle-blower National Health Service Corps NC Rural Heatlh Patient Safety Quality Assruance Steve Eblin Source Type: blogs

What Would Newt Do? Making Value-Based Care Victorious
By MICHAEL MILLENSON Health care’s much-trumpeted transition “from volume to value” care remains more tepid than transformational, according to a new study. Looking at 22 health systems nationwide, RAND researchers found that compensation continues to be “dominated by volume-based incentives designed to maximize health systems revenue.” Although confusing payment schemes bear part of the blame, there are deeper problems that appeared in sharp relief when I chanced upon a long-ago PowerPoint from a prominent political strategist and early advocate of “data-driven reimbursement.”  I refer, of cour...
Source: The Health Care Blog - February 21, 2022 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Health Policy Public Health HITCH act Michael Millenson Newt Gingrich Source Type: blogs

What the Pandemic Taught Us About Value-based Care
By RICHARD ISSACS You’ll recall that we ran a long piece (pt 1, pt 2) about Medicare Advantage from former Kaiser Permanente CEO George Halvorson earlier this year. Here’s a somewhat related piece from the current head of the Permanente Medical Group about what actually happened there and elsewhere during the pandemic–Matthew Holt The COVID-19 pandemic has provided important lessons regarding the structure and delivery of health care in the United States, and one of the most significant takeaways has been the need to shift to value-based models of care. The urgency for this transformation was cle...
Source: The Health Care Blog - February 17, 2022 Category: Consumer Health News Authors: matthew holt Tags: Health Policy Medical Practice Physicians Kaiser Permanente Medicare Advantage Pandemic Richard Isaacs value-based care Source Type: blogs