Andrew Dreyfus, president and CEO of Blue Cross Blue Shield of Massachusetts.
Blue Cross Blue Shield of Massachusetts announced this week that it is taking the radical step of paying to keep patients out of the hospital.
In a partnership with South Shore Health System in Weymouth, Mass., BCBSM will change the financial reward system so that it will tie payments to health system to its success in collaborating with physicians to improve quality, patient outcomes and costs for the patients they physicians and health system. Under BCBSM’s Alternative Quality Contract (AQC), the health insurer will reward the health system and physicians for their success in doing so, the two parties said in an Oct. 30 news release. 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
In April, Anna Wolfe, who covers health care for the Mississippi Clarion Ledger, started reporting on what appeared to be staggeringly high bills for using the emergency room at the Batson Children’s Hospital, in Jackson. The hospital is part of the University of Mississippi Medical Center, the only academic medical center in the state.
Parents who brought their children to the ER were being charged thousands of dollars in unreasonable emergency room facility fees that do not match the level of care received, Wolfe reports. Since that article was published April 15, Wolfe has continued to cover the complex ways the hospital calculates its charges. In the bills Wolfe reviewed, the hospital adds facility fees for ER visits, fees that are based on the level of care administered. Continue reading
Journalists who had been looking for stories about the high cost of medical bills came across an unexpected one – the astoundingly high price of rabies treatments.
WebMD investigative reporter Brenda Goodman and Georgia Health News CEO Andy Miller began their investigation late last year after Miller received a tip about a Georgia resident who owed more than $10,000 for her treatment. Continue reading