FOCUS OF THE WEEK
In South Dakota, the Narrow Network Question Will Be Settled By the Voters
A ballot question to limit narrow networks in South Dakota evokes the outcry that occurred when managed care first sought to rein in costs in the 1990s. Critics of the measure say its passage will push up premiums 20 percent.
For the Right Employers, ACOs Can Bring Shared Savings
The accountable care organization, or ACO, can be a mechanism for employers to achieve healthcare savings, according to a just-published article in The American Journal of Accountable Care, the publication of The American Journal of Managed Care dedicated to healthcare reform.
Three More Quit Medicare’s Pioneer ACO Program
Life for accountable care organizations (ACOs) in Medicare’s Pioneer program appears to be as tough as that on the prairie itself: only the strongest are surviving. Yesterday, 3 more ACOs exited the program, according to numerous news reports. This morning the web site for the Centers for Medicare and Medicaid Services’ Pioneer program listed only 19 ACOs from the original 32 that were part of the initiative when it launched in 2012.
Uncompensated Hospital Care to Plummet $5.7B Due to ACA; States Expanding Medicaid Benefit Most
Managed care has an answer to what happens when previously uninsured patients suddenly gain coverage: the cost of uncompensated care falls substantially, and so do the numbers of patients showing up at hospitals and emergency rooms without insurance.
In Wake of RAND Study, What’s the Future of Bundled Payments in Managed Care?
So far, the recent failure of a high-profile bundled payment pilot in California has not slowed enthusiasm for the concept from CMS.
AJMC Editorial Making Waves in Managed Care
Since it appeared last week, the editorial in the September issue of The American Journal of Managed Care, “Is All ‘Skin the Game’ Fair Game? The Problem With ‘Non-Preferred’ Generics,” has received comment in The New York Times, ProPublica, US News and World Report, and Mother Jones, among others. Commentators note that what Gerry Oster, PhD, and Co-Editor-in-Chief, A. Mark Fendrick, MD, uncovered in their brief survey of health plans is not just disturbing but possibly violates the Affordable Care Act’s prohibition against discrimination based on pre-existing conditions.
Quality Care Measurement, Other Managed Care Notes from Psych Congress
Measuring quality in psychiatric care and using mindfulness-based stress reduction techniques for better pain management were some of the ideas of interest to managed care professionals at the 27th US Psychiatric and Mental Health Congress, which opened Saturday in Orlando, Florida.
Calls for Transparency in Healthcare Pricing Gain Steam
One of the most vexing problems in managed care is the lack of pricing transparency: patients can't act like consumers when they don't have information on what they are buying. This week, the need for healthcare pricing transparency took center stage in several places.
Report Finds "Perverse Incentives" Add Costs to Dying When Patients and Families Want Less
Sweeping changes to the way America delivers care at the end of life would better serve patients and their families while bringing the healthcare savings that managed care has long sought, according to the Institute of Medicine report, “Dying in America,” which was released yesterday.
Study Finds Companies’ Pledge Led to Drop in Calories Sold
A study published today found that 16 major U.S. food companies that pledged to cut calories from foods sold consumers cut 6.4 million calories, or 10.6 percent, over a five-year period ending in 2012. Authors of the study say the results show that selling Americans healthier food need not be at odds with a healthy bottom line, and that “the results should encourage other manufacturers and retailers to follow suit.”