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The Urban Institute and the Catalyst for Payment Reform have collaborated on a series of briefs about various forms of health payment reform. Over the summer we’ll look at some that are receiving a lot of attention from policymakers and payers.
Let’s start with capitation. The recent Centers for Medicare & Medicaid Services (CMS) announcement about Comprehensive Primary Care Plus (CPC+) isn’t a switch to a fully capitated system. But this five-year model, scheduled to launch in January, does offer a degree of capitation, and moves further toward shifting more payments to a per-patient fee. Let’s look at what Urban/Catalyst says about the benefits and drawbacks of a capitated primary care payment system. Continue reading
House Speaker Paul D. Ryan (R-Wis.)
The House Republicans have released an Obamacare replacement plan – though it’s sparse on details. That’s partly because the Republicans themselves don’t agree on all the specifics – and it’s partly because politically it doesn’t really behoove them to put out all the details and let Democrats shoot it down between now and November.
Most of the ideas you’ve heard before – high-risk pools ($25 billion for that over 10 years, one of the few specifics in the GOP white paper), tax credits, tax-favored health savings accounts, the ability to buy insurance across state lines (which critics say undermine consumer protections). Continue reading
Drug prices have become a hot topic – and a significant source of the ongoing challenges to achieving affordable premiums and out-of-pocket costs in both Affordable Care Act exchange plans and employer-sponsored coverage. Drug costs are now the single largest health care concern of Americans across the political spectrum, according to some polls.
But it can be hard to know where to go to find out information about drug pricing and drug value (which aren’t the same thing). Continue reading
Once again, the Affordable Care Act was in court.
In a case brought by House Republicans, a federal district judge ruled on May 12 that the cost-sharing subsidies are illegal. Congress had never explicitly appropriated those funds. The White House contends that the authority to spend the money is in the ACA statute itself. The judge didn’t buy it. Continue reading
The Affordable Care Act created many opportunities for Medicare to test new ways of paying for health care. One of the biggest and most dramatic tests is now getting underway: bundled payments for hip or knee replacement.
Unlike most Center for Medicaid and Medicare Innovation (CMMI) projects on payment and delivery reform, this one is mandatory for hospitals in 67 geographic areas designated as participants. The test began April 1 and is supposed to run for five years. Continue reading