Katie Sullivan, MA

The Affordable Care Act was implemented to change healthcare in the United States. In order to support that change, the government established the Center for Medicare and Medicaid Innovation (CMMI)-a sector of the government agency that aims to incentivize innovation among providers and payers.

HHS said that many Medicare Advantage plans wrongly inflated patient risk scores, costing the government billions. Although no insurers were specifically named, HHS researchers said it was evident that the practice of overbilling was occurring industry wide.

With the speed at which technology advances, it can be surprising that the majority of US medical records are not yet available electronically - but the nation is gradually making the transition to great electronic health record (EHR) use.

The concept of a single-payer health system remains somewhat controversial among some legislators, yet Vermont continues to embrace the transition despite the challenges.

New research found that the risk of developing breast cancer increased in women who had mutations of a gene related to BRCA2, the PALB2 gene.

Older patients who are diagnosed with HIV/AIDS present a variety of challenges for providers, especially when it comes to controlling their costs of care.

The number of young adults who are at risk for mental health problems and substance abuse are now increasingly seeking care due to a provision of the Affordable Care Act (ACA).

A new report suggests that the cost of hepatitis C (HCV) drugs -including Gilead Sciences Inc.'s $1,000-a-day treatment Sovaldi-will increase federal spending for Medicare Part D as much as $3 to $6 billion in 2015.

According to a recent survey, hospitalists said that the 2-midnight rule is negatively impacting patient care as well as patient finances.

CMS has announced that it will nearly double the number of candidates in its bundled payment program. As part of the Affordable Care Act, the program aims to reduce care costs and improve patients' quality of care by offering providers with an alternative to the traditional fee-for-service reimbursement model.

According to the Centers for Disease Control and Prevention, the risk of the Ebola virus spreading to the United States remains low. Still, many US healthcare stakeholders are now taking steps to ensure that the disease does not spread to state-bound Americans. So far, the disease-which kills 90% of people who become infected with it-has infected more than 1,200 people in 3 West African countries and killed an estimated 700 of them.

Text messaging might just be the next best thing in patient engagement-at least according to the results of 1 organization's pilot program.

Although the state and federal health insurance exchanges have most recently taken the national spotlight, attention may soon turn to private health exchanges.

This week, the nation turned its attention to the split rulings of 2 state federal court of appeals.

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.

A federal appeals court panel ruling in Washington, DC, if upheld, could majorly impact the Affordable Care Act.

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.

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.

Health insurers are increasingly turning to telehealth, a transition that will change the way that providers assess and treat patients.

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.

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.

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.

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.

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.

Federal agencies remain committed to increase patients' access to affordable, high quality, and comprehensive healthcare.

The Affordable Care Act (ACA) prohibits insurance companies from rejecting new customers based on their pre-existing health conditions. Yet, a recent report alleged that 4 Florida-based payers may have structured their prescription drug benefit plans in a way which does just that.

A CMS proposal would increase the number of quality measures that accountable care organizations (ACOs) would have to achieve under the Medicare Shared Savings Program in 2015.

Although some providers still operate under the traditional fee-for-service reimbursement model, that is likely to change. Payers, employers, and government agencies are increasingly choosing to reward value over volume.

Consumers thinking about becoming enrolled in health insurance exchange plans may gain access to a new low-premium, high-deductible option: the copper plan. However, these plans have many patient advocate groups and policy experts concerned about their "bare-bone" offerings.

The number of healthcare organizations participating in CMS's bundled payment program is expected to increase in upcoming weeks.