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Dual eligibles, individuals enrolled in both Medicare and Medicaid, are among the highest-need, highest cost patients in the United States. Although it is difficult to determine the exact number of dual eligibles, a 2012 Kaiser Family Foundation report estimates that dual eligibles comprise 21 percent of the Medicare population and 15 percent of the Medicaid […]
Where Are ACOs Headed? At this pivotal time in the accountable care movement, future ACO growth will determine whether accountable care moves from a series of exploratory programs toward mainstream adoption across the country. A significant contributor to future growth is the success of today’s ACOs and their continued involvement in the ACO model, which […]
Dual-eligible enrollees account for a disproportionately sizeable proportion of spending in both Medicare and Medicaid programs. However, until recently, these nearly 11.5 million[i] enrollees have not been in the spotlight in discussions regarding the move toward value-based payments.
Micro-Hospitals Defined While the health care industry continues to shift from volume to value, costs of inpatient care continue to rise, averaging $2,346 per inpatient per day. Consequently, payers and providers are seeking new ways to reduce hospital length of stay (LOS) and deliver care at less costly locations. One such mechanism is the […]
On May 18, Leavitt Partners Health Intelligence Partners hosted over 25 health care leaders from both the public and private sectors to discuss opportunities for advancing chronic disease prevention and management. Ursula Bauer from the Centers for Disease Control and Prevention, former Acting Assistant Secretary of the Department of Health and Human Services Karen DeSalvo, Dr. […]
As telehealth gains traction as a way to deliver health care, Medicare reimbursement remains a major obstacle to broad implementation due in part to scoring methodology from the Congressional Budget Office (CBO). Rather than decreasing health care costs, CBO’s scoring methodology assumes that telehealth increases utilization and therefore overall costs. Recent legislation on the Hill, […]
On April 1, 2016, the Comprehensive Care for Joint Replacement (CJR) model program took effect, affecting roughly 800 hospitals across 67 markets. Prior to the program becoming active, Leavitt Partners published a blog post stating, “Time will tell whether hospitals and providers will succeed with quality improvements and savings generation under this new program.” One […]
Introduction During the 1970s, in an effort to limit rising health care expenditures, several states adopted various forms of all-payer rate-setting models, where all payers pay the same price for services at a given facility. Over time, most state models failed and only Maryland’s all-payer hospital rate-setting system remains. Recently, there is renewed interest in […]
Bundled payments are a great option for organizations that are interested in taking on risk, but don’t have the appetite to form an ACO. Bundle payments group costs associated with a particular treatment or episode of care, offering health systems a longitudinal look at the care cycle that can help them efficiently allocate resources. The CMS Bundled […]
Background The Centers for Medicare and Medicaid Services (CMS) has initiated a process whereby physicians and other stakeholder entities can design physician-focused payment models (PFPMs) that fit with their clinical practices, while also providing better outcomes for patients, and recommend such models to the Health and Human Services Secretary (the Secretary) for consideration and/or further […]