Finally, we may be seeing the beginning of the end of fee-for-service payment.
In an announcement Monday, the federal Department of Health and Human Services set two goals for changing how Medicare will pay for care, making the most significant change in payment in its 50-year history. First, HHS Secretary Sylvia Mathews Burwell said that next year, 30 percent of all payment to Medicare providers would be in alternative payment programs that reward hospitals and physicians for how well they care for patients rather than how much care they provide.
By 2018, 50 percent of payments would go into alternative payment programs, such as accountable care organizations, patient-centered medical homes and bundled payments, she wrote.
“In alternative payment models, providers are accountable for the quality and cost of care for the people and populations they serve, moving away from the old way of doing things, which amounted to, ‘the more you do, the more you get paid,’” Burwell added. Continue reading
At a recent San Francisco Bay Area chapter event, health journalists received a primer on the narrowing networks of current health plans and the delicate balance between managing health care costs and providing reasonable access.
Panelists Anne Price, director of the Plan Management Division of Covered California; journalist and “Ask Emily” columnist Emily Bazar of California HealthCare Foundation’s Center for Health Reporting; Larry Levitt of Kaiser Family Foundation; and Betsy Imholz of Consumers Union addressed narrow networks’ impact on consumers, insurers, and providers, as well as proposed government regulation. Marilyn Serafini of nonpartisan Alliance for Health Reform, the panel’s cohost, moderated the briefing.
Narrow networks predate the Affordable Care Act to the controlled HMOs of the 1980s and 1990s, Levitt explained. The ACA accelerated the trend as insurers sought new ways to cut costs under a law that capped deductibles, banned pre-existing condition denials and mandated certain preventative care benefits. Continue reading
I’m sure a lot of you have Steven Brill’s “America’s Bitter Pill” on your bedside table by now – I’m not going to try to recap it here.
But I did want to share a few links to some of the more thoughtful (or provocative) articles and reviews, representing critics on both the left and right. I also wanted to draw your attention to another recent book providing a conservative perspective on health reform. Continue reading
Tim Darragh has written a “How I did It“ essay on his yearlong project looking at a community-wide effort to reduce hospitalization and ER use among a group of “superusers,” people who have complex medical conditions and use a whole lot of very expensive health care. Many have multiple medical problems, often including mental illness or other behavioral issues. We also wrote about his work a few weeks ago.
Darragh looked at a specific program financed under the Affordable Care Act in the Allentown, Pa., area. (He was at The Morning Call at the time. He recently moved to New Jersey Advance Media, which publishes The Star-Ledger and NJ.com.) But hospitals and health care systems across the country are looking at ways to reduce avoidable hospitalizations and rehospitalizations; the incentives are part of the ACA, and insurers are also demanding this to reduce costs. Addressing these patients’ needs before they become a crisis that lands them in the ER isn’t just a money-saver. It’s also better health. Continue reading
Back when states were deciding whether to run their own exchanges or let the feds do it, they also had to make a lot of decisions about how their exchanges would operate.
One question was whether to have a “clearinghouse” and let any health plan that met the legal requirements participate in the marketplace. The other option was to be an “active purchaser,” and to have the state exchange directly negotiate with the health plans over premiums, provider networks etc.
The rationale, for each model: Continue reading
One of the high-profile programs within the Affordable Care Act is the drive to reduce preventable hospital readmissions among the Medicare population. The program focuses on fee-for-service patients who came back to the hospital within 30 days. Hospitals in the third year of the program face a fine of up to 3 percent of their Medicare payments. Kaiser Health News analyzed the most recent CMS hospital data, and found more than 2,600 hospitals faced penalties in the last round and could lose $400 million.
Reducing unnecessary hospitalizations is a good idea, pretty much a slam-dunk quality move.
But is the readmissions program using the right metrics? Are hospitals that are doing all the right things cutting both readmissions and admissions – and therefore facing penalties because the proportion isn’t dropping, the readmission rate is the same share of the total admissions? Some new research suggests that may be the case. As Joanne Lynn, M.D., a geriatrician and prominent health policy researcher put it (and I’m paraphrasing), it’s the denominator, stupid. Continue reading
A recent Health Affairs blog post by Heather Howard (a familiar name to AHCJ members who have attended the panels or webcasts she’s done for us) and her colleague Galen Benshoof at the State Health Reform Assistance Network (housed at Princeton) outlined an aspect of the coming King case on exchange subsidies. The information was new to me, and may be unfamiliar to other reporters too. I’ve summarized the key points below and included story ideas at the bottom. You can read the original (more detailed) post here.
The Affordable Care Act (ACA) encourages state innovation in many ways, but one of the most significant is the “Wyden waivers” or the State Innovation Waivers program in section 1332 of the law. They become available in 2017, although planning can start earlier.
Some states are thinking about taking these waivers, which include “exchanges, benefit packages, and the individual and employer mandates.” States can get all the federal money that would have gone into those provisions – hundreds of millions or even billions of dollars – but they have to provide comparable coverage and it must be affordable. HHS and Treasury have released some guidance but not a whole lot of detailed rules and instructions.
The Atlanta chapter of AHCJ and the Alliance for Health Reform sponsored a Dec. 2 event focused on the second open enrollment period for the Affordable Care Act.
The panel discussed the state of navigator assistance, narrow networks and slower-than-expected enrollment since the insurance exchanges opened Nov. 15. About 25 AHCJ members and invited guests gathered for the event.
Joining me on the panel were Trey Sivley, a division director in the office of Georgia’s Insurance Commissioner; Lisa Stein of Seedco, which runs a navigator program in Georgia and three other states; and Dorian Martindale of Whitefoord, a federally qualified health center in Atlanta.
We post new resources on the Health Reform section of the website every month, and encourage you to visit and explore. But we wanted to draw your attention to some that are particularly timely.
Image by Sean via flickr.
- The Kaiser Family Foundation has a new tool, Mapping Marketplace Enrollment. You plug in a ZIP code and then you can see how many people are eligible for a federal exchange plan, and what proportion signed up in 2014 “within a 100,000-resident statistical-geographical area associated with the ZIP code.” It also provides demographic information, and can be used to make comparisons, including statewide.
- Louise Norris, a licensed broker who writes and blogs about insurance and the Affordable Care Act has done a 38-page e-book guide to Open Enrollment (Note: I’ve skimmed half of it, not read every word, but I have seen some of Norris’s work in the past.)
- We recently posted about closures of rural hospitals, and a reader pointed us to this recent issue brief from the Centers for Disease Control and Prevention. It looks at rural residents who are hospitalized – who goes to rural hospitals and who “bypasses” them to go to urban ones.
- ProPublica just launched a web app that allows consumers – and journalists – to look up their current plan to see how premiums, deductibles and out-of-pocket costs will change next year, or compare all 2015 plans offered in an area.