Health Care Cost

A new payment model through the Affordable Care Act seeks to decrease cardiovascular disease for tens of thousands of Medicare beneficiaries by assessing patient risks for heart attack and stroke and then helping them to reduce those risks.

The suits are on behalf of providers and health insurance customers and involve some famous plaintiffs' attorneys.

The authors discuss the success of the Pioneer ACO model and the Comprehensive Primary Care Initiative, among others. They outline an agenda that includes engaging managed care stakeholders, so that both public and private payers are moving toward value-based payment.

According to Robert Pozen, non-resident senior fellow at Brookings, government healthcare plans were 17.5% higher cost than the average citizen's plan, while their employee contributions were 45% less than the average plan. If these patterns continue, many state and city healthcare plans will run up against the "Cadillac" tax in 2018, he predicts.

Medicare's new payment formula is set to begin in 2019. The problem is no one's agreed on standards for measuring quality or efficiency of patient care.

An independent review of Medicare payments reveals that 42% of the healthcare dollars Medicare paid to providers in its fee-for-service program in 2013 were designed to boost the value of care patients receive.

At a webinar convened by AISHEalth, "Private Exchange Strategies: What's Working Today? What's Next?" Ashish Kaura and Jay Godla, both partners with Strategy&, provided insight into the challenges faced by private exchanges.

The Pioneer ACO Model successfully reported smaller increases in total Medicare expenditures and reductions in health service utilization, for savings of approximately $385 million during the first 2 years compared with general Medicare fee-for-service.

As accountable care organizations work to deliver population health, patient satisfaction, and cost savings, the need to engage patients as partners in their own healthcare has never been more essential. The ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care, gathered this week at the historic Hotel del Coronado in San Diego, California, to explore ways to make patients the starting points of healthcare, not just its recipients.

Patients at hospitals with high rates of skilled nursing facility discharge usually have poorer outcomes and higher downstream spending, according to researchers from Massachusetts Institute of Technology and Vanderbilt University.

Studies have shown that embedding behavioral health services into the primary care practice produces better health outcomes for patients with diabetes, while reducing indications of depression. The challenge is figuring out how to make the transition to new payment models that reward such care.

A one-minute look at managed care news during the week of April 20, 2015, including the how payment reform could hurt emergency care and Americans want the government to do something about high drug prices.