Tag Archives: costs

Primary care physicians find value-based payments fail to cover their costs

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

It’s hard to imagine any physician starting an online fundraising effort to keep her practice open. But for Michelle Mitchell, M.D., a solo physician who runs Hawaii Family Health, the business model for primary care in her state is unsustainable otherwise.

She wants to raise $250,000 via a GoFundMe page that explains many of the financial problems she and her 15-member staff face running a practice that serves 2,500 patients in Hilo, the capital of the Big Island.   Continue reading

Amazon Berkshire’s health care initiative hires expert in contracting for quality

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Dana Gelb Safran

Last spring, Atul Gawande, M.D., became chief executive officer of an unnamed initiative that will cover the health costs of 1.2 million employees and family members of Amazon, Berkshire Hathaway and J.P. Morgan. Shortly after being named CEO, Gawande said the initiative would aim to eliminate three kinds of waste in the health care system: administrative costs, high prices, and inappropriate use of health care services, as Zachary Tracer reported for Bloomberg News.

Last week, we got a clue about how Gawande might approach these three challenges when the initiative hired Dana Gelb Safran, Sc.D., from Blue Cross Blue Shield of Massachusetts. Continue reading

Event provides perspectives on California’s health policy landscape

Emily Willingham

About Emily Willingham

Emily Willingham (@ejwillingham) is AHCJ's core topic leader on the social determinants of health. She is a science journalist whose work has appeared in the Washington Post, San Francisco Chronicle, Wall Street Journal, Scientific American, and Forbes, among others, and co-author of "The Informed Parent: A Science-Based Guide to Your Child's First Four Years."

Photo: Elliot Margolies via Flickr

Health Affairs held an October event in Sacramento on California’s health policy landscape (also available as a podcast).

Here are some highlights from the panelists, all of whom are excellent potential sources for stories about health care policy in California and around the nation: Continue reading

BCBS of Massachusetts will pay to keep patients out of the hospital

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

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

Is value-based health care a fad?

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Photo: Robert Geiger via Flickr

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

Ohio Medicaid program demands new payment strategy after journalists explain how PBMs use ‘spread pricing’

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Photo: afagen via Flickr

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