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This Week in Managed Care: August 8, 2015


The top stories in managed care, including what providers really think about the use of quality metrics, readmission rates for Medicare patients, and preventing drug-resistant infections.

This week HHS found that competition among health plans in the Affordable Care Act’s insurance marketplaces helped consumers find the best prices. However, there are now concerns that if the mergers between Aetna and Humana, and Anthem and Cigna go through that they will decrease competition levels that led to better prices and premiums.

The use of quality metrics to assess providers’ performances is viewed negatively by primary care providers, along with financial penalties for unnecessary hospital admissions and readmissions. However, providers believe health information technology is having a positive impact on quality of care.

Under the Hospital Readmissions Reduction Program, 2592 hospitals will lose a combined $420 million dollars due to penalties as a result of their Medicare readmission rates. One in 5 Medicare patients is still readmitted to the hospital within 30 days of discharge.

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