Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Health Reform' Category

The demise of PPOs in Health Insurance Exchange

A Robert Wood Johnson commentary by Katherine Hempstead provides insight into the evaluation of PPO offerings in health insurance exchange. Since last year there has been a significant reduction in the number of PPOs offered in the Affordable Care Act (ACA) marketplaces. A prior analysis showed that of the 131 carriers offering silver PPO products […]

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Who is participating in BPCI?

In 2013, Medicare launched the Bundled Payments for Care Improvement (BPCI) initiative.  There were 4 models included in the program: Model 1 (least comprehensive): includes Part A services for the index hospitalization alone, and thus most closely resembles current fee-for-service payment. Model 2 (most comprehensive): encompasses Part A and Part B services for the index hospitalization, readmissions, and all other post […]

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Share of Small Employers Offering Health Insurance

Although the ACA certainly expanded health insurance coverage, mostly through subsidies, creation of insurance exchanges, and Medicaid, small businesses generally did not expand coverage.  A RWJ report from Lucia et al. (2015) used MEPS-IC data to track insurance offering among businesses with fewer than 50 workers. Part of the reason is the rise of health insurance […]

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“An astonishingly naïve approach”

That was Amitabh Chandra’s comment on Hillary Clinton’s plan to reign in drug prices and I don’t disagree. According to the N.Y. Times, her plan: …includes regulating the percentage of revenues pharmaceutical companies must spend on research and development, instituting a cap on the cost of many out-of-pocket drugs for chronic and serious health conditions, and allocating […]

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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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ACO Characteristics

In recent years, payers have moved towards shifting more financial risk to providers.  One of the most significant ways financial risk is passed to providers is through the creation of Accountable Care Organizations (ACOs).  The biggest ACO program is Medicare’s Shared Savings Program (MSSP).  Are ACO’s improving quality and reducing cost?  A paper by Schulz, […]

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ACA driving up health care spending?

That is the conclusion reached by John Holahan and Stacey McMorrow in a RWJ Issue Brief. They claim that “recent reports suggest such growth has returned to a more typical level of approximately 5.6 percent in 2014, considerably faster than increases in gross domestic product (GDP).” Positive excess cost growth–defined as the difference between the […]

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ACC/AHA Statement on Measuring Treatment Value

The conventional premise governing performance measures and guideline recommendation…is that all healthcare professionals should act in the best interests of their patients without regard to costs. However, as the cost of medical care has increased, specialty societies are increasing considering the cost of care when selecting treatments. For instance, A recent survey reported that slightly […]

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“Affordable” Care Act

Is the Affordable Care Act making health insurance more affordable?  Generally, the answer is yes.  More individuals are insured due to Medicaid coverage expansions in some but not all states and the implementation of health insurance exchanges.  However, there is one worrying trend in affordability: increasing patient cost sharing. A paper by Hempstead et al. (2015), […]

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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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