Elisabeth Rosenthal’s latest piece on the craziness of our health care pricing looks at affordability of health care for people covered by the Affordable Care Act.
For people purchasing insurance, premiums are only part of the cost, although they are what many consumers focus on when they choose a plan. There are also deductibles, co-pays, and different rules for in-network and out-of-network care. For people covered by ACA exchange plans, costs can mount, big time, and it can be very confusing for patients to figure out what they are being or will be charged. Continue reading
We’ve posted a new tip sheet and a new “How I did it” piece that may yield some story ideas for reporters.
In her “How I did it” essay, Karen Brown describes how she tracked a group of primary care residents for a year of their training – a year in which two of the three she chose to focus on ultimately decided not to go into primary care after all.
“Their decisions may have been disappointing for the field, but they did make for a more compelling story. I was able to use their personal dilemmas, unfolding in real time, to illustrate the crisis in primary care,” she writes. Brown had an AHCJ fellowship to do her project, but she gives advice on how to embark on a similar project – without a fellowship – in your community.
In the tip sheet, Lola Butcher explains the 340B drug program, which requires pharmaceutical companies to sell discounted drugs to eligible health care organizations that serve a lot of poor people. The drugs are for outpatient use.
But the program has continued to grow, prompting questions about its cost and purpose. “Like all good controversies,” Butcher writes, “this one has enthusiastic advocates and wild-eyed opponents, and it’s easy to get snagged by the passion of the partisans.”
Both feature projects were funded with AHCJ Reporting Fellowships in Health Care Performance.
Independent journalist Lola Butcher reports that debate about the government’s 340B Drug Pricing Program continues to build as the program expands.
“Like all good controversies, this one has enthusiastic advocates and wild-eyed opponents, and it’s easy to get snagged by the passion of the partisans,” she writes in a new tip sheet. Continue reading
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