Unbiased Analysis of Today's Healthcare Issues

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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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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Do you support ACOs?

Do you support Accountable Care Organizations?  Many policymakers think they are a great idea.  Why?  If ACOs better integrate care coordination between a variety of physician specialists and other providers, ACOs can increase the efficiency of the health care system.  Improving quality and reducing cost sounds like a great idea. To implement these integrated care settings in […]

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Why providers love ACOs

“The good thing about the systems not being highly integrated and coordinated is that premiums are lower. Why are those hospitals and physicians [integrating]?  It wasn’t for increased coordination of care, disease management, blah, blah, blah—that was not the primary reason. They wanted more money and market share.” A Fresno, California medical group physician Using […]

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