Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Health Insurance' Category

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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Trends in Value-based reimbursement

A McKesson study cites 7 trends in value-based reimbursement: Rapid adoption of VBR. About 90% of payers and 81% of providers are already using some mix of value-based reimbursement (VBR) combined with fee-for-service (FFS). Collaborative regions are more aligned with VBR. Collaborative regions, where one or two payers and providers stand out, are more aligned […]

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Obamacare premium increases overstated?

Health insurance premiums appear will rise modestly or even decline for many Obamacare plans in state Health Insurance Exchanges.  A RWJ brief reports: Premium increases will be quite low between 2014 and 2015. In the rating areas we examine in the 17 states plus the District of Columbia, six states will have average premium reductions across the carriers’ […]

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Who will pay the Cadillac tax?

Beginning in 2018, many individuals will face the “Cadillac” tax. What is the Cadillac tax? The Cadillac tax is a tax on high-cost health insurance plans. According to a Truven report, it is calculated as “40 percent of the excess of total per employee per year (PEPY) healthcare costs above statutory threshold limits of $10,200 […]

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How do states plan to control Obamacare premiums?

Obamacare mandates that individuals need to buy health insurance or else they will face a financial penalty. This threat, however, is not credible unless there are affordable health insurance options for most Americans. What are states doing to hold down health insurance rates in the ACA’s health insurance exchanges? A RWJF working paper provides some […]

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Healthcare.gov vs. Amazon.com

Which one is easier to use?  The answer to this is clear: Amazon.  Of course, health insurance is a much more difficult product for people to understand than most good at Amazon.  However, many policymakers may have underestimated the amount of customer service new enrollees in Healthcare.gov need.  The Washington Post reports: Just 13 percent of assistance […]

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How did the ACA affect Employer-Sponsored Insurance?

Most people think that the Affordable Care Act (ACA) has focused on decreasing uninsurance rates by creating health insurance exchanges, providing subsidies for health insurance premiums for these exchanges, and expanding Medicaid. The ACA also has affected a number of other segments of the health care industry. Less well known is that the ACA also affected […]

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