Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Medicaid/Medicare' 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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What’s new for Medicare Advantage in 2015

A KFF article provides some highlights of changes to Medicare Advantage for 2015: Near universal access to an MA plan.  99% of Medicare beneficiaries will have access to a Medicare Advantage plan as an alternative to traditional Medicare in 2015.  The only individuals without access to an MA plan are concentrated in a few rural areas. Lots of […]

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Regional Growth in Medicare Spending, 1992–2010

Below is an abstract from a paper I co-wrote with Camille Chicklis, Thomas MaCurdy, Jay Bhattacharya, and Dan Rodgers.  The title of the paper is Regional Growth in Medicare Spending, 1992–2010. Objective: To determine if regions with high Medicare expenditures in a given setting remain high cost over time. Data Sources/Study Setting: One hundred percent of national Medicare Parts […]

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What’s wrong with the SGR?

Why are doctor’s always complaining about the sustainable growth rate (SGR) issue? What is the SGR? The Brookings blog has a nice primer on the SGR. What is the SGR Put in place through the Balanced Budget Act of 1997, the SGR is a system designed to control the costs of Medicare payments for physicians. […]

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Medicare to Pay for Value

I have spilled much ink on this blog discussing the pros and cons of pay-for-performance approaches to medicine.  Incentivizing high quality care is good in theory, but in practice changes in quality have been modest and providers may be able to readily game the system.  Despite these challenges, Medicare announced this week that it would being  tying 30 […]

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How did Obamacare affect Medicaid enrollment?

The Affordable Care Act (ACA) contained the provision requiring States to significantly expand Medicaid eligibility. The Supreme Court, however, ruled that states had the option of implementing this provision.  Thus, the change in Medicaid eligibility and subsequent enrollment varied significantly across states based largely on whether or not they were an expansion state.  A recent […]

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Insurance does not equal health care

One part of the Affordable Care Act extended Medicaid benefits to millions of Americans.  One problem, however, is that patients with Medicaid insurance often have trouble finding doctors who will treat them.  The New York Times reports: Large numbers of doctors who are listed as serving Medicaid patients are not available to treat them, federal […]

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Medicaid Expansion States

Which states have decided to receive additional federal funds to expand the share of people they cover under Medicaid?  The Kaiser Family Foundation has the answer. Alabama Not Moving Forward at this Time Alaska  Not Moving Forward at this Time Arizona Implementing the Medicaid Expansion  Arkansas Implementing the Medicaid Expansion California  Implementing the Medicaid Expansion Colorado Implementing the Medicaid Expansion […]

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Treating Dual Eligibles

The PBS Newshour has an interesting story on the treatment of the 9 million dual-eligible beneficiaries in the US.  They discuss integrated care model in California, Cal MediConnect.  

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