Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Health Reform' Category

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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Obamacare subsidies stand

Although I mentioned on Wednesday that there are some bills pending that could strip away some aspects of the Affordable Care Act (i.e., medical device tax, IPAB), the core components of the ACA were upheld by the Supreme Court. The BBC reports: In a 6-3 decision, the justices said that tax subsidies that make health […]

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Obamacare’s slow repeal?

While we are waiting for the King v. Burwell verdict, which could repeal large sections of Obamacare, the house of representatives has already approved rolling back some ACA provisions. Modern Healthcare reports: Lawmakers postponed final passage of the proposed Protecting Seniors’ Access to Medicare Act despite a majority voting in favor of the bill. The […]

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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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Obamacare in Mississippi

An interesting article from Politico shows that Mississippi was instituting a program—known as One Mississippi—that would allow small businesses employees to come together to purchase insurance at lower rates. It was seen as a conservative politically as it helped those who were working to access healthcare. This is exactly what one of the provisions of […]

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Medicaid Expansion and States’ bottom line

A recent RWJF Issue Brief notes that states that expanded Medicaid received more revenue from the federal government and had less state-level spending on programs that support the uninsured. In examining Medicaid expansion across eight states—Arkansas, Colorado, Kentucky, Michigan, New Mexico, Oregon, Washington and West Virginia—it is clear that states are realizing savings and revenue […]

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Transitioning to Alternative Payment Models

CMS has stated that they want 30% of all fee-for-service payments to be transitioned to alternative payment models–such as pay for performance–in the upcoming years.  A future where all providers are paid capitation or based on some measure of value is not here yet.  And in the interim, providers are dealing with a complex system […]

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5 Trends 5 years after by ACA

From a PwC report on “Five trends to watch as the Affordable Care Act turns five“: Risk Shift: Raising the stakes for all healthcare players. The ACA added force to new payment models that reward outcomes and penalize poor performance such as high rates of readmission and hospital-acquired conditions. Primary care: Back to basics. Experimentation […]

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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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