Press Releases

A California law that limits the size of bills from out-of-network physicians for care delivered in hospitals appears to be protecting patients’ financial liability, but has shifted bargaining leverage in favor of insurance plans and had potential unintended consequences such as encouraging more consolidation among physician practice groups, according to a new RAND Corporation study published in The American Journal of Managed Care®.

Some large employers and policy makers advocate for retail competition that relies on providers competing on healthcare performance. Using diabetes care in Minnesota as an example, researchers examined whether the public reporting of care measures encouraged health systems to improve their clinics’ diabetes care performance in the latest issue of The American Journal of Managed Care®.

Social determinants of health, including stress, social support and environmental hazards, among other factors, impact the lives of patients beyond the clinic door. It is unclear which health system stakeholders should own the responsibilities of improving these health-related measures, yet US payment systems are moving to hold individual providers accountable for associated health improvements. This represents a misalignment of accountability and capability, write two researchers in a viewpoint from the current issue of The American Journal of Accountable Care®.

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