FOCUS OF THE WEEK
Dual-Eligibles Not Opting Into State Care Coordination Programs
To better align the care of beneficiaries insured under both the Medicaid and Medicare programs, CMS invited states to participate in a 3-year demonstration project. However, it seems that many beneficiaries have opted out of these care coordination programs that are offered across the country.
DC Court Ruling is a Setback for ACA
A federal appeals court panel ruling in Washington, DC, if upheld, could majorly impact the Affordable Care Act.
CMS Announces Changes to Medicare Hospice Drug Rule
Changes to a hospice drug rule will reduce the types of medications that require prior authorization. Previous rules prohibited Medicare hospice patients from filling their Part D medications until they had confirmed that hospice providers did not cover them first.
Value-Based Care: Thinking Beyond Financial Incentives
When it comes to value-based decision making, several factors can influence physician behavior. Although many organizations rely on financial incentives, the Commonwealth Fund argued in a report released Tuesday that healthcare leaders should think beyond the dollars and dimes.
Stakeholders See Benefits with the Use of Telehealth
Health insurers are increasingly turning to telehealth, a transition that will change the way that providers assess and treat patients.
HHS Provides $100M to Support States' Medicaid Reform Efforts
HHS announced that it would distribute more than $100 million to states in a new initiative called The Medicaid Innovation Accelerator Program (IAP). The program intends to improve Medicaid programs and lower costs through technical support from the agency.
NCQA Proposes Integration of Medical Homes and Ambulatory Clinics
The National Committee for Quality Assurance (NCQA) proposed a program that would integrate patient-centered medical homes (PCMHs) with nontraditional ambulatory sites. If adopted, the program would assess the quality of care delivered at practices such as ambulatory care, urgent care centers, retail clinics, and worksite clinics.
Clinical Documentation Improvement Helps Providers with ICD-10 Transition
Most providers associate clinical documentation improvement (CDI) with the transition to ICD-10 coding, however, CDI — a process in which care providers receive feedback from specialists who review clinical documents — may also deliver clinical and financial benefits for healthcare organizations.
Insurer's New Payment Model Saved Millions for Oncology Groups
One insurer’s experimental reimbursement model proved to lower the total costs of care for patients with 3 types of cancer. As an alternative to the traditional fee-for-service payment model, the episode payment model—which reimburses physicians on a fixed-price, based on episodes of best-practices and patient outcomes—provided encouraging findings in the battle against the rising costs of cancer care in the United States.
Insurer Sees Success with Patient-Centered Medical Home Program
The patient-centered medical home (PCMH) has been described as a model of “whole person” care delivery, 1 that is designed to support the goals of the Triple Aim. With team collaboration, the PCMH enhances patient access as well as their continuity of care. Now, 1 insurer reports that 1.1 million people who received care through its PCMH in 2013 were not only hospitalized less often, but they reported shorter lengths of stay than patients in fee-for-service care.