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On October 13, 2015, your humble blogger received the AIS Inside Health Insurance Exchange quote of the day related to non-payment of the Risk Corridor payments, “…. there was a contract going into this that there would be certain protections… and plans would price as best as they could, knowing that there was no actuarial precedent for the risk. The news that CMS could pay carriers 12 cents for every dollar requested for the first year of the risk corridor program felt like Lucy moving the football at the last second.”
On Monday, January 23, U.S. District Judge John Bates issued his highly-anticipated decision regarding the Department of Justice’s anti-trust challenge that blocked the proposed $37 billion- merger between Aetna and Humana. The ruling in favor of the Department of Justice (DOJ) is significant because of the merger’s potential to cause Medicare Advantage disruptions and other […]
Emergency medical services (EMS) evoke images of EMTs and paramedics responding to medical crises and transporting patients to the hospital rather than thoughts about value-based care and changes in health care delivery and payment models. EMS leaders are trying to change that paradigm through a movement dubbed “EMS 3.0.” EMS 3.0 aims to make emergency […]
The Government Accountability Office (GAO) recently issued a report outlining five key areas in which smaller, rural physician practices tend to struggle as they shift from fee-for-service reimbursement to value-based care. Given the unique nature of rural medicine, and the fact that value-based payment will continue to grow, it is important to understand these challenges […]
PAC represents the next frontier of opportunity for the success of ACOs, BPCI Model 2 participants, and CJR hospitals. In fact, of the ACOs which achieved shared savings, most attribute their success to closer PAC care coordination. Hospitals are narrowing networks, wanting to find the best PAC partners possible, and stronger care pathways and coordination are taking place at unprecedented levels.
One potential ACA replacement strategy could include punting health care reform to the states. The incoming administration could accomplish this is by significantly relaxing the 1332 innovation waiver requirements.
From a security perspective the last 24 months have proven to be quite detrimental to the health care industry with dozens of successful and very public and costly cyber / malware attacks. These attacks are relentless and increasing. As the health care industry explores solutions to mitigate and defend against attacks, one technology that is […]
Not Losing Sight of the Dual Eligible in the Move to Value Based Payments Value-based payments arrangements are increasing. While most of this movement is being driven through Medicare-based payment initiatives, CMS is now increasingly pushing value-based payments in Medicaid based on the success CMS has achieved in Medicare. The shift to value-based payments is […]
Medicare Advantage (MA) offers Medicare benefits through private health plans, providing an alternative to the traditional, federally-administered program. Also known as Medicare Part C, this private option traces its roots to the 1970s and received its current name and form in the Medicare Modernization Act of 2003. Since then, the number of enrollees has grown […]
Insurance premiums under the Affordable Care Act (ACA) are receiving increased attention due to reports of sharp 2017 increases by insurers. Across the nation, insurers have submitted initial premium increases and it is not uncommon for insurers to submit proposed rate increases in excess of 40-50% for 2017. State regulators will review the requests meticulously […]