Health Care Delivery

CMS' Sean Cavanaugh announces in a blog post that 89 newcomers will participate in 2015. But ACOs remain a work in progress, with rule changes on the way and some discussion about whether these entities are assuming enough risk or dampening competition in certain markets.

The most important case since the Supreme Court upheld the constitutionality of the Affordable Care Act will determine the law's ability to function in states without their own exchanges.

Accountable care organizations (ACOs) are still a new creature in the world of managed care, and not all are alike. As the authors of a new comparative analysis in The American Journal of Managed Care outline, Medicare contracts dominate the ACO landscape, with only half of these entities having a contract with a private payer.

Although Virginia Gov Terry McAuliffe failed to pass a Medicaid expansion plan during his first year in office, the governor's health secretary has indicated that the fight will begin again.

More than 700 hospitals will be penalized in fiscal year 2015 as a result of poor scores in CMS' Hospital-Acquired Condition (HAC) Reduction Program.

The falling uninsured rate among all racial/ethnic groups under current Medicaid expansion decisions will narrow coverage differences between whites and all minority groups except for blacks, according to a report from the Urban Institute.

Over the long haul, Paul Gionfriddo expects that the Mental Health Parity Act will help rectify the situation where mental health professionals are paid so inadequately for the services, although in the short haul the effects are much more subtle.

Fresh off re-election, Governor Robert Bentley moved this week to name 6 groups to coordinate managed care in Medicaid, as part of a cost-saving strategy he launched in 2012. But the bigger news has been his reversal on expanding the program; as in other Southern states, hospitals have been pressing for the change to solve fiscal problems.

The employer and individual mandates, not Medicaid expansion and state-run exchanges, are what raised the ire of Republicans who gave opinions on the ACA in the most recent Kaiser poll.

States designing and testing healthcare payment and service delivery models to improve quality of care and lower costs will be receiving more than $665 million in funding from the government, according to HHS Secretary Sylvia M. Burwell.

How do ACOs reach the point of delivering both savings and better care? The recent online session of the ACO and Emerging Healthcare Delivery Coalition, sponsored by The American Journal of Managed Care, covered how ACOs evolve, how that process applies to oncology care, and how managed care can benefit from a better model for mental health delivery.

An attorney for the patient said this is the first lawsuit that alleges actual harm over inadequate networks, not just lack of access. California has had its share of growing pains through ACA expansion and its simultaneous expansion of managed care in its Medicaid program.

After a quieter open enrollment period, HHS officials give a final call for current customers to make changes to existing plans.

Tennessee became the latest Republican-led state to gain approval for a Medicaid expansion option when Gov Bill Haslam unveiled the Insure Tennessee plan Monday morning. There are just 20 states left that have not expanded Medicaid.

The 2014 elections are likely to have minor, but noticeable impacts on the future of the Medicaid program, both in terms of federal conversations on entitlement reform and in state approaches to the Medicaid expansion.

As Medicaid enrollment grows under the program's expansion, there are not enough providers to serve the increased amounts of enrollees, according to a new report from the Office of the Inspector General that measured the availability of specific providers in Medicaid managed care networks.

The study published in Health Affairs recommends standardization of benefit plans across states for children, especially those related to developmental abilities.

Highly-paid doctors make more money ordering multiple procedures for individual patients than they earn seeing multiple patients, suggesting payment reform under the Affordable Care Act has yet to be realized.

The federal government may have made strides to improve the health insurance exchanges since last year's open enrollment, but a majority of Americans view shopping for health insurance as just as bad as or worse than doing their taxes.

Republicans in the US Congress plan to renew their attacks on President Barack Obama and his signature healthcare plan on Tuesday when they grill a consultant who said "the stupidity of the American voter" helped ensure the law's passage.

One criticism of the Affordable Care Act is that it imposes a costly, one-size-fits-all standard, drastically increasing premiums by requiring everyone to buy health insurance that covers the same mandated benefits. This is not so.

For 2015, marketplaces' ability to conduct an effective renewal process for current enrollees is constrained by their information technology capacity, the short time period for open enrollment, and limited resources for outreach and consumer assistance.