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Archive for the 'Health Insurance' Category

What is Comprehensive Care for Joint Replacement?

Bundled Payments for Care Improvement (BPCI)A helpful post from Steven A. Farmer, Meaghan George and Mark B. McClellan explains.  Comprehensive Care for Joint Replacement (CCJR) is a bundled payment structure for hip and knee replacements.  CMS notes that: 2013, there were more than 400,000 inpatient primary procedures in Medicare, costing more than $7 billion for hospitalization alone. […]

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Rate hikes in 2016

The Affordable Care Act may turn out to be not so affordable.  From the New York Times: Health insurance companies around the country are seeking rate increases of 20 percent to 40 percent or more, saying their new customers under the Affordable Care Act turned out to be sicker than expected. Federal officials say they […]

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ACA and narrow networks

One way for insurers to reduce health care costs is to restrict patient access to only lower cost providers.  This phenomenon is known as narrow networks.  On the one hand, narrow networks can promote efficiency by driving down provider price and directing patients to the highest value physicians.  Alternatively, if insurers use narrow networks to direct patients […]

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Covered California and Adverse Selection

The Affordable Care Act requires all individuals to be offered the same premium regardless of health status. Although there are some ratings bands based on age and smoking status, most people who purchase insurance on health insurance exchanges receive the same premium for any given insurance product from any given insurance company. The insurance products […]

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Obamacare, Narrow Networks, and Quality

There are a number of ways plans in health insurance marketplace can lower their premiums.  One option is to increase cost sharing.  Plans in the bronze and sliver tier have much lower premiums than those in the gold and platinum tier.  Within any tier, plans can restrict patient access to lower cost providers; this also will reduce […]

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What are “conditions specific to military service”?

Just before Memorial Day, a Maryland congressman recently proposed shrinking the scope of services the VA provides to veterans.   How would he do this? He proposes a model: …where the VA is not the place of general health care for the veterans, but the place of highly-specialized care where skilled professionals are particularly well-equipped to […]

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The Next Generation ACO

Medicare currently has two Accountable Care Organizations (ACOs)–the more popular Medicare Shared Savings Program (MSSP) and the Pioneer ACO program. However, these ACOs have generated only limited cost savings. Only 11 of 23 Pioneer ACOs and 58 of 220 MSSP participants generated cost savings. To address some provider concerns and due to the limited cost […]

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A Medicaid ACO?

Medicare’s Shared Savings Program (MSSP) contracts with accountable care organizations (ACOs) to provide care for Medicare beneficiaries.  Reimbursement levels for these ACOs depends on quality and their ability to generate cost savings relative to the non-ACO national trend.  The goal is to align provider and payer incentives in improving quality and reducing cost. Would such a […]

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Narrow Networks

One of the ways health plans in the health insurance exchanges have been able to keep premiums down is through offering beneficiaries very narrow networks. By steering patients towards “efficient” doctors, premiums stay low. However, patients may worry that these “low cost” doctors are lower quality than those outside of the network. The tradeoff between […]

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Do quality rankings matter?

There have many policy initiatives to measure and improve quality of care.  For instances, NCQA’s HEDIS measure are the most widely used quality measures among commercial insurers.  Since employers generally choose insurance plans for employees (or at least select the menu of insurance options for employees), one would expect that employers would look for high […]

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