Unbiased Analysis of Today's Healthcare Issues
Although Health Reform did little to reduce the cost of health care, it did make significant strides to expand access to care. For low-income individuals, the increased access comes along two dimensions: expanded Medicaid eligibility and increased physician fees. Specifically, Health Reform required to Make all individuals with incomes below 138% of the Federal Poverty…
Health reform not only changes the health care market for the demand side (e.g., patients, insurers), but also for the supply side (e.g., hospitals, physicians). In the Medicare setting, a number of initiatives have aimed to pay providers who provide high-quality or low-cost care more money, and pay providers who provide low-quality or high-cost care…
The answer depends on the state. Today, I examine an Urban Institute research paper that looks at this progress in more detail. Dividing States into 3 Group The most advance States fall into Group 1 (CA, CO, CT, DC, HI, IN, MA, MD, NV, OR, RI, UT, VT, WA, WV). These states have either enacted…
One of the provisions in the Patient Protection and Affordable Care Act (a.k.a ACA, a.k.a. Health Reform, a.k.a. Obamacare) is that it limits the profits of health insurance companies. The ACA imposes a minimum medical loss ratio (MLR) on all insurers. The MLR is the amount of money spent on covered person medical care divided…
For many years, fee for service payment was the status quo. FFS model encourages hospitals to adopt the following strategies to maximize market share and profits: Centered on short-term acute care Focused on specialist alignment Driven by a volume-based service-line strategy Using expensive medical equipment purchases to encourage physician referrals Attracting patients with new construction…
Health Reform’s Accountable Care Act (ACA) mandates the creation of Accountable Care Organizations (ACOs). Dartmouth researcher Elliott Fisher stimulating much of the interest in ACOs by introducing the concept of an “extended hospital medical staff” at a 2006 meeting of the Medicare Payment Advisory Commission (MedPAC). Today, I review an article by Berenson and Burton (2011) describing…
Starting in fiscal year 2014, Medicare will start rewarding hospitals with high quality care and penalizing hospitals with low quality care. The rewards and penalties will be financial in nature. High-quality hospitals will receive a bonus and low-quality hospitals will receive a financial penalty. There is a lot of existing documentation on this hospital value-based…
One of the key tenets of health reform is that insurers cannot charge different premiums to individuals based on their pre-existing conditions. Under this type of system, the optimal strategy for many individuals is to not buy any health insurance until one gets sick. Since insurers cannot charge these sicker people higher premiums based on…
Last year, I mentioned how ACO requirements will lead to more industry consolidation. A recent article by the Economist is finding that my prediction is becoming a reality. “Cigna, an insurer based in Connecticut, said it would pay $3.8 billion for HealthSpring, which offers services and insurance to the elderly. It is the latest deal…
The California Healthcare Foundation (CHCF) notes that States face a number of challenges when determining how to design their Health Exchanges mandated by health reform. Today, I briefly highlight some of the requirements State Exchanges must fulfill.