Unbiased Analysis of Today's Healthcare Issues
Medicare’s Shared Savings Program (MSSP) is a program that created accountable care organizations (ACOs). Providers in get bonuses if they are able to reduce health care costs and also maintain quality. In theory, the program makes sense, increase reimbursement for high-quality, low-cost providers. The key question, however, is whether it works. A recent study in NEJM…
For most managed care plans, beneficiaries elect to participate in the plan. In exchange, beneficaries often have lower premiums, but often restricted access to providers (e.g., referral requirements, copayment differentials for out-of-network physicians). Medicare’s Accountable Care Organizations (known as Shared Savings Plans (SSP)) also assign beneficaries to organizations. The SSPs are groups of providers that…
Medicare recently release a request for proposal for health care agencies to participate in both the Medicare Shared Savings Program and the Pioneer Accountable Care Organization (ACO) pilot project. The Pioneer ACO project is similar to the Shared Savings Program but has higher levels of cost sharing and (in year 3 of the pilot) partially…
Do you support Accountable Care Organizations? Many policymakers think they are a great idea. Why? If ACOs better integrate care coordination between a variety of physician specialists and other providers, ACOs can increase the efficiency of the health care system. Improving quality and reducing cost sounds like a great idea. To implement these integrated care settings in…
“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…