Who are the high-cost patients?

Accountable care organizations are responsible for managing the quality and cost of patients.  However, a small share of patients make up a large share of health care cost.  How can ACOs improve the care and reduce the cost of these patients? First, ACOs need to understand the needs of high-cost patients.  A perspective by Powers and…

P4P in Medicaid

Does Medicaid use pay-for-performance (P4P) for providers?  If so, how does it work?  And does it affect quality and cost? These are the questions of interest to Rosenthal et al. (2015) in their study of P4P programs in Alabama, Minnesota, and Pennsylvania.  Although all three focus on physicians, the Alabama program is a “medical home ”…

HWR is up

Louise Norris has a freshly posted Healthcare Reform: The Path Forward Edition of Health Wonk Review at Colorado Health Insurance Insider. She notes that it’s been nearly six years since the ACA was signed into law – and particularly in this election year, it’s all about the path forward.

Health insurance in China

Although China has the world’s largest economy, the average individual is actually fairly poor.  Average incomes in the country are less than $15,000 per year, ranking #121 in the world.  However, a vast majority of Chinese have health insurance due to some recent reforms. A paper by Zhang et al. (2016) uses data from the 2011-2012 China…

Managing post-acute care cost

Medicare’s move towards bundling payment for acute and post-acute care means that hospitals have an incentive to carefully monitor care received after discharge.  But what are the key drivers of post-acute care cost: hospital readmissions? use of any post-acute care? type of post-acute care used? A paper by Huckfeldt et al. (2016) examines Medicare claims data…

FFS vs. Capitation Reimbursement: Responses by Physicians and Medical Students

How do people respond to financial incentives?  In the medical world, physicians often are paid fee-for-service (FFS) or capitation.  Physicians receiving FFS reimbursement receive additional compensation for each additional service they do.  For instance, physicians under FFS receive twice as much compensation for 2 office visits as they would for 1 office visit.  On the other hand,…