Unbiased Analysis of Today's Healthcare Issues

“The medical marketplace is broken”

This quote is from David Blumenthal, a physician and former Harvard Medical School professor, who was the national coordinator for health information technology between 2009-2011.  He describes in an interview for the Atlantic why adoption of electronic medical records has been so slow in the U.S. From the patient’s perspective, this is a no-brainer. The benefits […]

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Are ACOs working?

Maybe. An press release from CMS is very upbeat on ACOs. What do the numbers say? Farzad Mostashari and Ross White review the CMS report and find that results were mixed: Of the 114 ACOs in the program, 54 of the ACOs saved money and 29 saved enough money to receive bonus payments. The 54 […]

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A glitch in ACO beneficiary assignement?

For most managed care plans, beneficiaries elect to participate in the plan. In exchange, beneficaries often have lower premiums, but often restricted access to providers (e.g., referral requirements, copayment differentials for out-of-network physicians). Medicare’s Accountable Care Organizations (known as Shared Savings Plans (SSP)) also assign beneficaries to organizations. The SSPs are groups of providers that […]

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Accountable Care Organizations in Medicare

I have written numerous posts about the pros and cons of Accountable Care Organizations.  In 2012, Medicare begame allowing providers to form ACOs.  An article by Pope and Kautter provides an overview of the initiative. The Medicare program, which covers the elderly and disabled, is the largest medical insurance system in the USA. One major […]

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Rationing comes to Massachusetts

Massachusetts legislature passed a first-in-the-nation bill limits the growth of health care costs in the state. “The bill would not allow spending on health care to grow any faster than the state’s economy through 2017. For five years after that, any rise in health care costs would need to be half a percentage point lower […]

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Medicare Reforms Linking Reimbursement Rates with Hospital Performance

Health reform not only changes the health care market for the demand side (e.g., patients, insurers), but also for the supply side (e.g., hospitals, physicians).  In the Medicare setting, a number of initiatives have aimed to pay providers who provide high-quality or low-cost care more money, and pay providers who provide low-quality or high-cost care […]

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Accountable Care Organizations: Update on Medicare Implementation

Health Reform’s Accountable Care Act (ACA) mandates the creation of Accountable Care Organizations (ACOs).  Dartmouth researcher Elliott Fisher stimulating much of the interest in ACOs by introducing the concept of an “extended hospital medical staff” at a 2006 meeting of the Medicare Payment Advisory Commission (MedPAC). Today, I review an article by Berenson and Burton (2011) describing […]

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What’s the difference between an ACO and Managed Care?

Medicare recently release a request for proposal for health care agencies to participate in both the Medicare Shared Savings Program and the Pioneer Accountable Care Organization (ACO) pilot project.  The Pioneer ACO project is similar to the Shared Savings Program but has higher levels of cost sharing and (in year 3 of the pilot) partially […]

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Alternative Quality Contract

“In January 2009 Blue Cross Blue Shield of Massachusetts launched a new provider payment system called the Alternative Quality Contract that exemplifies the type of experimentation with novel payment models that the Affordable Care Act encourages. The Alternative Quality Contract is a modified global payment model in which annual payments to medical groups are linked to a per member per month budget.” Today I […]

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Legal Barriers to ACO implementation

Accountable Care Organizations (ACOs) are the latest rage in health policy circles.  Health reform legislation will allow for federal health agencies to create waiver programs to allow for the creation of ACOs.  For ACOs to actually come to fruition, the waivers must take into account existing laws which currently greatly limit the scope under which […]

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