One of the problems with the fee-for-service payment system is that it’s a flawed method of payment for sick patients but it may be ever more flawed as a method of payment for those who are healthy. This point is one Katy B. Kozhimannil, Ph.D., made recently in an article for the American Journal of Managed Care.
An associate professor in the Division of Health Policy and Management at the University of Minnesota School of Public Health, Kozhimannil wrote that payment models should compensate teams of physicians, midwives, nurses and other providers for delivering evidence-based services during pregnancy, childbirth and the postpartum period. These payment systems also should be based on the health risks of the mother and baby, she added. Continue reading
The federal Centers for Medicare and Medicaid Services launched the Hospital Compare website to let consumers evaluate hospital performance based on a star-rating system. For those seeking to analyze hospitals’ overall scores, the site is useful but its one-size-fits-all approach limits how much patients can design searches to match their individual needs.
Now researchers at the Rand Corporation have built a tool called the Personalized Hospital Performance Report Card that allows users to review, customize, and compare hospitals across the United States and develop their own custom ratings based on their most important performance areas. Continue reading
There’s no doubt that the health system needs new payment models to replace the aging fee-for-service (FFS) method criticized for providing incentives for physicians to do more procedures, prescribe more drugs, and see more patients more frequently.
Among efforts to control costs and improve patient outcomes, health insurers and health systems have been shifting from the FFS model, which drives volume, to a payment model that rewards value. They hope value-based payment will help keep costs down while improving patient outcomes. Health system marketers call it better care at lower cost. Continue reading
Over the past six months, journalists for the Columbus Dispatch have written more than 40 articles about the murky world of pharmacy benefit managers (PBMs) in Ohio. This week, they wrote one of the most important stories in this ongoing series, “Ohio firing pharmacy middlemen that cost taxpayers millions.”
In this article, they explained that the Ohio Department of Medicaid was changing the way it pays for prescription drugs by, “giving the boot to all pharmacy middlemen” because the Medicaid program wants to shift away from what’s called the “spread pricing” practice. Continue reading
When covering prescription drug pricing, one problem that journalists face is understanding the almost-labyrinthine complexity of the drug supply chain, from manufacturer to consumer.
For one of its first investigations, the young publication Tarbell set out to explain why drug prices are so high. In doing so, Tarbell Editor Randy Barrett describes in great detail the complex world of pharmacy pricing. Continue reading