Why providers love ACOs

“The good thing about the systems not being highly integrated and coordinated is that premiums are lower. Why are those hospitals and physicians [integrating]?  It wasn’t for increased coordination of care, disease management, blah, blah, blah—that was not the primary reason. They wanted more money and market share.” A Fresno, California medical group physician Using…

How will Health Reform Affect You?

The Robert Wood Johnson Foundation has put together a series of briefs which explain how Health Reform will affect various types of consumers.  These briefs include: Young adults, Seniors, Children, Individual and small-group premiums. Hospitals, and Physicians. Although are a lot of these types of guides out there, the RWJ briefs are generally fairly comprehensive…

Does Health Reform Change the Malpractice System

Health Reform (a.k.a. Patient Protection and Affordable Care Act [PPACA]) provides two small provisions that will affect malpractice costs.  Randall Bobvjerg explains: “As enacted, PPACA contained only two, quite limited malpractice provisions.  Section 10607 authorized malpractice demonstrations by states, and section 10608 extended federal malpractice protections to free clinics’ nonmedical personnel. The demonstration authority comes…

Who’s running the Patient-Centered Outcomes Research Institute (PCORI)?

As part of Health Reform, the government created the a center to study clinical effectiveness of different health treatments.  This center, known as the Patient-Centered Outcomes Research Institute (PCORI), “does not have the power to mandate or even endorse coverage rules or reimbursement for any particular treatment.”  What leverage does the Institute have?  Not too…

Three Tiers of Accountable Care Organizations

The Healthcare Economist has previously reviewed different forms of Accountable Care Organizations (ACOs).  Implementing ACOs in practice, however, may prove more difficult.  How could the government or private insurers incentivize providers to provide integrated care?  How can they incentivize providers do perform fewer services and, thus, make less money? An article by Shortell and Casalino…

Center for Medicare and Medicaid Innovation

Medicare and Innovation in the same sentence?  Yes indeed. As part of Health Reform [i.e, Patient Protection and Affordable Care Act (PPACA)], the government mandated the creation of the Center for Medicare and Medicaid Innovation (CMI). What does CMI do?  “The stated purpose of the CMI is to test innovative payment and service delivery models…