278 results for medicare

In two original articles published in The American Journal of Accountable Care, the Duke-Margolis Center for Health Policy and Leavitt Partners examine quality improvements and cost savings in the first four years of the Medicare Shared Savings Program (MSSP), and suggest opportunities for system-wide improvement. The authors examined outcomes for ACOs over time using the […]

As health care costs continue to consume an increasingly large share of the federal budget and impact Americans’ personal finances, it is important to understand the various drivers of those costs. The literature documents how higher levels of concentration (lack of competition) among commercial payers and providers contributes to higher premiums for commercial health plans. Less well understood, however, is the relationship between the concentration of Medicare Advantage (MA) plans in a market and MA premiums. Our paper uses a fixed-effects, multivariate regression to evaluate the association of both MA plan concentration and health system concentration on MA premiums. We found that increased concentration (lower competition) in the MA insurance market was associated with higher MA premiums and that if all beneficiaries were in markets at least as competitive as the average market today, they would pay nearly $200 million less in annual premiums. We also found that the highest premiums were in markets that lacked competition among MA payers and hospital markets, suggesting the interaction between MA insurer concentration and hospital system concentration matters. Our findings suggest that maintaining or increasing current levels of competition is necessary for controlling MA premiums.

Salt Lake City, November 15, 2017 – With Medicare Advantage open enrollment period already underway, it is important to examine the Medicare Advantage premiums paid by beneficiaries. Today, Leavitt Partners released, “Medicare Advantage Premiums Higher in Markets with Concentrated Health Plans,” a white paper that examines the relationship between the concentration (a measure of market competition) of Medicare Advantage plans and the out-of-pocket costs to beneficiaries, as well as the association between health system concentration and Medicare Advantage premiums.

The Centers for Medicare and Medicaid Services (CMS) has shown significant support for the development of Alternative Payment Models (APMs). CMS’ development and testing of 45 payment models has led to the adoption of similar models by other payers. Initial reports indicate that APMs could be key to producing the health care delivery reform necessary to decrease health care costs and increase delivery quality. However, these models are only available to select provider types, and some providers, such as emergency physicians and audiologists, have no Medicare APMs in which they can participate. To realize the full benefits of APMs, additional collaboration between CMS leadership and providers is needed to develop new models for providers who do not currently have access to them.

Salt Lake City, September 11, 2017 –  Alternative Payment Models (APMs) have gained bipartisan support as a medium to produce the health care delivery transformations necessary to decrease health care costs and increase the quality of care. Today, Leavitt Partners released a new white paper, “Medicare Alternative Payment Models: Not Every Provider Has a Path […]

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 […]

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, […]

The Centers for Medicare and Medicaid Services assigns a star rating to Medicare Advantage plans to help beneficiaries better understand and select their insurance plan.  When selecting an insurance plan, quality and cost are typically the top selection criteria used.  This study looks at the relationship between these two important factors – quality (in star […]

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 […]

On July 7, 2016, CMS released a proposed rule on Medicare payment policies that supports the expansion of the National Diabetes Prevention Program (National DPP) model. This brief also explains that this proposed rule will support the expansion of the National DPP in other payer models as well.

Nathan Smith is a senior analyst based in Salt Lake City. As a senior analyst, Nathan works directly with the research and development team managing data-related client work and internal research tasks. Using CMS Limited Data Set (LDS) 2013 claims data, I examined the distribution of all Medicare fee-for-service (FFS) costs. The LDS claims file […]

Each year CMS releases its Limited Data Set (LDS) claims data for all Medicare beneficiaries. Medicare claims data provides a wealth of information that can be used to inform researchers, policy makers, and commercial entities about health care trends throughout the country and in particular locales. I used the 2013 Medicare denominator data file to […]

Leavitt Partners releases “Ten Early Takeaways from the Medicare Shared Savings ACO Program” white-paper containing market landscape and trends analysis. Salt Lake City, April [5], 2016 —The importance of Medicare’s Shared Savings Program (MSSP) results cannot be overstated. Organizations considering participation want to assess their peers’ performance and the program’s ultimate viability. Positive results encourage […]

The importance of Medicare’s Shared Savings Program (MSSP) results cannot be overstated. Organizations considering participation want to assess their peers’ performance and the program’s ultimate viability. Positive results encourage more providers to enter the valuebased world. Negative and/or ambiguous results not only discourage new member entry, but could also incentivize program departures. Using a combination […]

After what felt like a long wait, on January 11th CMS finally announced the 2016 Medicare ACO participants. The announcement included the first group of Next Generation ACO (NGACO) participants and the newest cohort (the sixth overall) in the Medicare Shared Savings Program (MSSP). With this update, CMS now has 477 ACOs participating across four […]

Opioids are a class of drug primarily used in the treatment of pain. According to the NIH, The number of people both using and abusing opioids has increased significantly since 1999. Scientific research has revealed several deleterious effects associated with opioid prescription drug abuse. The primary concern with increased opioid prescribing is the high probability […]

Join Leavitt Partners for a tabletop conversation on current and future initiatives for the Medicare program in Washington, DC on November 19. Charlene Frizzera, Senior Advisor and FuturePanel member, will facilitate three thought-provoking sessions that will address some of the most critical questions regarding Medicare, including: What is Medicare’s strategy to achieve its value goals, what […]

Introduction.  I’m a firm believer that data has a story to tell, particularly if you are able to see what it says. While looking through pages of numbers may lead to some interesting insights, there’s a limit on what can be gleaned without translating the data into a more consumable format. Countless analysts have dabbled […]

The Comprehensive Care for Joint Replacement (CCJR) program, recently announced by The Centers for Medicare & Medicaid Services (CMS), establishes a new five-year program model to support better and more efficient care for common inpatient surgeries, specifically hip and knee replacements, at hospitals in 75 MSAs. Soon, hospitals will be influenced to decide whether or […]

In contrast to the 13 ACOs that very publicly left the Pioneer program, 27 participants have quietly disappeared from the Medicare Shared Savings Program (MSSP). Research by Leavitt Partners has found that while some of these MSSP ACOs have indeed left the program, most of the “missing ACOs” are the result of mergers with other […]

After much anticipation, CMS has issued its final rule for the Medicare Shared Savings Program (MSSP). The 592-page document describes changes to various aspects of the program including the option to extend time under the no-risk Track 1 for a second agreement period, and the addition of a new two-sided model, Track 3. CMS released […]

On the first day of December, 2014 CMS released a proposed rule to update the Medicare Shared Savings Program, the most prominent of the ACO programs being promulgated by the federal and various state governments. As a team, we devoured the 429-page rule, splitting it up along certain topics like attribution and financial model options; […]

Just last week, CMS announced that it would like to transition Medicare to value-based payments at a quicker pace.  The government will evaluate whether patients are getting healthier through measurement, while having the goal of delivering half of all Medicare payments through value-based arrangements by 2018.[1] While the ambition of transitioning payments towards value isn’t […]

Medicare Advantage (MA) continues to be one of the fastest growing public sector programs in the country. Motivated by enhanced choice and flexibility, seniors are increasingly purchasing these products as an alternative to traditional Medicare.  The last couple of years, in particular, have seen tremendous MA growth; broadly accepted growth projections, as shown in Exhibit I, are […]

An article by Michael O. Leavitt and Tevi Troy published by TheHill.com on September 20, 2011. Governor Leavitt was Health and Human Services secretary from 2005 to 2009. Tevi Troy, a senior fellow at the Hudson Institute, was deputy HHS secretary from 2007 to 2009, and a senior White House aide from 2005 to 2007. […]

The Patient Protection and Affordable Care Act (PPACA) of 2010 utilizes savings in the Medicare Advantage program to support expansion of coverage elsewhere. PPACA adjustments to the payment formula reduce Medicare Advantage benchmarks (a per-member-per-month (PMPM) rate set by CMS for each county) and rebates (a rebate from CMS if a plans bid to serve […]

In an op-ed published in The Washington Post, Leavitt Partners founder and chairman Michael O. Leavitt shares his insights on how Medicare Part D has outperform expectations, and what Medicare Part A (hospital insurance) and Part B (health insurance) should learn from the prescription drug benefit plan. …Read Article Here…

By Dennis G. Smith. During the late 1970s, Saturday Night Live (SNL) featured a skit with Chevy Chase and Gilda Radner in which Ms. Radner, in the character of Emily Litella, would provide her views on topics of the day. After informed by the news anchor (Chase) that she misunderstood the topic, Litella would sheepishly […]

I was disappointed by Congress’s vote to override the President’s veto of the Medicare bill. Congress has shown an unwillingness to change the program’s path and take on the important task of entitlement reform. I wrote more about this in the following op-ed, which ran in The Washington Times: Yesterday, the president vetoed a Medicare […]

This will be my last post in the blog series on my comments to the Medicare Trustee’s Meeting, held on March 26, 2008. I have used the metaphor of canoeing whitewater rapids to explain the disaster that lies ahead on our current course and how safety depends on repositioning the boat. Yesterday, I explained how […]

So far in my blog series, I have talked about the serious imperative our nation has to change the course of Medicare. I also discussed several parts of a political construct that would allow political action. Now I would like to frame up, at a high level, what a solution should look like from my […]

Last night, I posted a brief entry about my conversation with Ted Kennedy, and today I am returning to my series on Medicare. In this series of blog posts, I am using the metaphor of navigating whitewater rapids to describe the dilemma of the Medicare problem facing our nation. I concluded my post yesterday by […]

This week, my blogs are focused on Medicare and the serious crisis we face in coming years. The thoughts in this series will be submitted as part of the minutes of the Medicare Trustee’s Meeting. In my last post, I outlined the current course for Medicare as it is drifting toward disaster. Would it be […]

I have started a series of blogs on the Medicare problem facing our country, using the metaphor of navigating whitewater rapids. Last week, I began “scouting the river” by discussing the current course and the generational divide, between workers and their parents and grandparents, that awaits us in the future. I have a son who […]

Yesterday, I started a series of blogs on Medicare. The thoughts in this series I will be submitting as part of the minutes to the annual Medicare Trustee’s Meeting, which was held March 26th. In my last entry, I introduced the metaphor of navigating the dangers of whitewater canoeing and addressing the tenuous future of […]

I want to begin a series of blog entries about the promise our nation has made to provide health care to our seniors. I am going to be critical of our current course. I don’t want to see us fail. To keep this commitment requires change. Time is running out. Medicare is drifting toward disaster. […]

Not long ago, a reader commented, “don’t you have more important things to do than write a blog.“ I have much to do, but I enjoy writing and appreciate the comments you make. However, the person raising questions about my blog time may feel better because I haven’t posted for a while. My absence was […]

I suppose the compulsion I feel to get people’s attention on the plight of the Medicare Trust Fund can be attributed to my current close association with it. Medicare is part of HHS and I’m also a Trustee. This week, I released our budget proposal for the next five years. Medicare makes up 56 percent […]

[Note: This afternoon, I notified Congress we (the Administration) support a requirement that doctors adopt e-prescribing and electronic medical records in order to get the full Sustainable Growth Rate update (HHS statement). I’ve written more below about why I think this is important.] When I was a boy, there was a Tennessee Ernie Ford ballad […]

Former Health and Human Services Secretary and Medicare Trustee Michael O. Leavitt characterized the annual trustees report on the future well being of Medicare as an illusion created by unrealistic assumptions and double counting. The 2010 Medicare Trustees Report (available on CMS.gov and in associated multimedia for this release) was issued yesterday. “The report has created the illusion that […]

Leavitt Partners chairman and senior advisor opine in The Washington Times about Medicare competitive bidding SALT LAKE CITY – (February 28, 2011) Leavitt Partners’ chairman Michael O. Leavitt and senior advisor Thomas Barker encouraged Congress to fix the flaws in Medicare competitive bidding, but continue to allow competitive forces to create value for Medicare beneficiaries […]

Michael O. Leavitt and Tommy G. Thompson, both former governors and U.S. Department of Health and Human Services secretaries, believe that the Medicare prescription-drug program (commonly referred to as Medicare Part D) serves as a model for the entire Medicare program. In a column published in today’s Orlando Sentinel they opine that Congress should look to the five-year […]

In a jointly authored opinion editorial published in The Washington Post, Michael O. Leavitt, former secretary of the U.S. Department of Health and Human Services, and Robert Krughoff, president of Consumers’ Checkbook/Center for the Study of Services, ask Congress to make Medicare claims data available to health care consumers, practitioners, researchers and others who will […]

Mark Smith, MD, MBA Mark Smith is currently a Professor of Clinical Medicine at the University of California at San Francisco and Visiting Professor at the School of Public Health at the University of California at Berkeley. He co-chairs the Guiding Committee of the Health Care Payment Learning and Action Network. From 1996 through 2013 […]

Salt Lake City, March 7, 2018 –Today, Torch InsightTM, Leavitt Partners’ data platform that provides deep insights into health care markets and organizational characteristics of industry sectors, announced a new resource that allows users to see market- and practice-level projections of how many physicians, by specialty, will leave practices in coming years. This new adaptation […]

Salt Lake City, February 28, 2018 – Value-based care is changing how physicians practice medicine and the training they need to practice successfully. Today, Leavitt Partners published an article in the New England Journal of Medicine Catalyst, “Preparing a New Generation of Physicians for a New Kind of Health Care,” that examines how medical schools […]

A McKnight’s Long-term Care News article entitled “Analysis: ACOs save money by shifting care away from skilled nursing facilities” summarizes the Leavitt Partners and Duke AJAC “Medicare Accountable Care Spending Patterns: Shifting Expenditures Associated With Savings” skilled nursing facilities (SNF) findings. The article specifically notes that a 1-percent decrease in spending on SNFs was accompanied […]

A RevCycleIntelligence article entitled “MSSP ACOs Save More By Spending Less on Inpatient, Post-Acute Care” highlights the Leavitt Partners and Duke AJAC “Medicare Accountable Care Spending Patterns: Shifting Expenditures Associated With Savings” piece. The article notes the study’s main findings and quotes the authors’ key takeaways.

David Muhlestein provided his insights into Allegheny Health Network building a new micro hospital in Westmoreland County, Pennsylvania for an NPR article entitled “Why Health Care Systems Are Building Micro Hospitals.” “This might be a market that has a lot of commercially insured patients, and commercial insurance tends to pay much higher than Medicare and […]

During the first year of the Trump administration, states have grappled with many unanswered questions regarding the new administration’s views on value-based payments (VBPs) and how it would approach state-led or Medicaid based payment reform initiatives. These include to what extent existing efforts will continue to be supported or renewed, what mechanisms states can or should use to implement VBPs (e.g., DSRIP programs, 1115 waivers, 1115A waivers), what financial support will be available, and how much flexibility the Center for Medicare & Medicaid Services (CMS) will grant states in designing and funding innovative models. In the past eight months, CMS has revealed what it will look for in these initiatives moving forward, such as a desire to support state innovation. This paper provides a historical perspective on VBPs, including the health care system’s move away from payment models based on fee-for-service, and an overview of state models focused on value and quality. The paper also outlines the Trump administration’s key signals to date and how they might impact state VBP efforts in 2018 and beyond.

Salt Lake City, February 20, 2018 –Today, Leavitt Partners released “Value-Based Payment in Medicaid: Signals for States,” a white paper that outlines the Trump administration’s key signals to date and how they might impact state value-based payment (VBP) efforts in 2018 and beyond.

Podcast: David Muhlestein discussed the Leavitt Partners “Medicare Advantage Premiums Higher in Markets with Concentrated Health Plans” white paper during a Hospital Finance Podcast (HFP). During the podcast, David talked about the data and methods, the results, and potential policy implications.

David Muhlestein provided his insights regarding ACOs taking on risk for a Modern Healthcare article entitled “More Medicare ACOs will take on risk in 2018.” David said, “Certainly (the numbers) are showing that more ACOs are taking on risk, but it’s not going to be mad dash. It is going to be a gradual, sustained movement.” He also noted that while “delivery transformation is really hard,” he expects additional ACOs will migrate to the “risky tracks” as MACRA is fully implemented. “There is certainly continued evidence that organizations are starting to figure this out,” Muhlestein said.

The latest information from the Centers for Medicare & Medicaid Services (CMS)[1] on the number of plan selections for the current Open Enrollment Period (EOP) has been a positive sign for stakeholders that are hoping for a large and stable enrollment cycle. While the number of plan selections has been higher than in the previous […]

David Muhlestein provided insight into the latest Medicare Shared Savings Program results for a Crian’s Chicago Business article entitled “How local hospitals led the way in a big Medicare cost-cutting experiment.” Regarding the overall program’s success, David said, “It’s certainly too early to say whether it’s been successful or not.”

A Provider magazine article entitled “Medicare Advantage Marketplace Snapshot Offers Clues to Providers” provides a detailed overview of the Leavitt Partners “Medicare Advantage Premiums Higher in Markets with Concentrated Health Plans” white paper. The article states, “Amid moves by some long term and post-acute care (LT/PAC) providers to expand into health insurance through the marketing of Medicare Advantage (MA) plans to residents, a new report by Leavitt Partners offers a glimpse of how the MA marketplace functions, and how the lack of real competition impacts consumers. This insight may give interested providers a deeper view of the opportunities and challenges the increasingly popular MA trade offers.”

A FierceHealthcare article entitled “Study: Medicare Advantage premiums higher in markets with less payer, hospital competition” highlights the Leavitt Partners “Medicare Advantage Premiums Higher in Markets with Concentrated Health Plans” white paper. The article references a few of the key findings and states, “Given these findings, researchers said policies that encourage competition, monitor current levels of competition and deter decreases in competition may help avoid future premium increases for MA beneficiaries.”

A RevCycleIntelligence article entitled “MSSP ACOs Improve Care Quality, Struggle to Realize Savings” highlights the “Medicare Accountable Care Organization Results for 2016: Seeing Improvement, Transformation Takes Time” Health Affairs Blog co-authored by David Muhlestein. The article outlines the study’s key findings, includes three of the study’s exhibits, and links to the original piece.

A Provider magazine article entitled “Medicare Advantage Marketplace Snapshot Offers Clues to Providers” provides a detailed overview of the Leavitt Partners “Medicare Advantage Premiums Higher in Markets with Concentrated Health Plans” white paper. The article states, “Amid moves by some long term and post-acute care (LT/PAC) providers to expand into health insurance through the marketing of Medicare Advantage (MA) plans to residents, a new report by Leavitt Partners offers a glimpse of how the MA marketplace functions, and how the lack of real competition impacts consumers. This insight may give interested providers a deeper view of the opportunities and challenges the increasingly popular MA trade offers.”

A FierceHealthcare article entitled “Study: Medicare Advantage premiums higher in markets with less payer, hospital competition” highlights the Leavitt Partners “Medicare Advantage Premiums Higher in Markets with Concentrated Health Plans” white paper. The article references a few of the key findings and states, “Given these findings, researchers said policies that encourage competition, monitor current levels of competition and deter decreases in competition may help avoid future premium increases for MA beneficiaries.”

David Muhlestein was interviewed for a Modern Healthcare article entitled “CMS loses money as Medicare ACOs remain risk-averse” examining the most recent federal data on the CMS Medicare Shared Savings Program (MSSP). “If everyone were at risk, it would have been a profitable year (for the CMS),” David said. He also noted that a $39 million loss (just 0.05 percent of the costs) is quite low for Medicare.

David Muhlestein commented on the most recent Shared Savings and Pioneer ACO model results for a Bloomberg BNA article entitled “Coordinated Care Models Save Medicare Big Bucks.” “Hospitals and physicians are continuing to join these models as they realize health care will eventually be paid on value-based payments,” David said. “Many ACOs are just starting to get used to the programs, therefore earning more savings”. The commentary was also referenced in a McKnight’s Long-term Care News article entitled “ACOs saved Medicare more than $700 million in 2016”.

According to a Healthcare Informatics article entitled “Specialty Societies to MedPAC: MIPS Should Stay Put,” the Alliance of Specialty Medicine referenced the Leavitt Partners “Medicare Alternative Payment Models: Not Every Provider Has a Path Forward” white paper in a letter to MedPAC noting its opposition to the commission’s recent suggestion to repeal the Merit-based Incentive […]

Webinar: Thursday, November 16, 2017 Despite foundational challenges, biopharmaceutical companies and payers are finding ways to align forces around mutually beneficial clinical outcome payment programs. Our panelists will discuss how such partnerships can navigate clinical and operational performance requirements, and what are the implications for patient adherence and dissemination of real world evidence. Additionally, we […]

By 2030, it is estimated that the United States will lack between 40,800 and 104,900 physicians. Moreover, there is a maldistribution of physicians across and within states. To address these projected shortages, some states, depending on their current environment, could bolster their supply of physicians by increasing their existing medical school enrollment or building new medical schools. We used data from the Medicare Physician Compare database to examine state retention of their medical school graduates and how a variety of factors, such as physician age, specialty, and gender, were related to a physician’s likeliness of practicing in their medical school state. We also analyzed the relationship between state retention of physicians and number of physicians per capita. We found that on average, states retain 38 percent of their medical school graduates and physicians who pursue a non-primary care specialty are more likely to leave their medical school state. We also observed a significant negative correlation between state retention and number of physicians per capita. Additional medical schools may not sufficiently address some state’s physician shortage unless other measures are also pursued, such as increasing residency positions. As states assess their physician supply and medical school graduate retention, there is also an opportunity for states to incorporate more value-based care training into the curriculum of both their existing and new medical schools. States may also consider encouraging the use of physician and non-physician care teams as an additional strategy to addressing their primary care physician shortage.

A RevCycleIntelligence article entitled “Specialists Face 16% MIPS Payment Adjustment Swing Under Proposal” references the Leavitt Partners “Medicare Alternative Payment Models: Not Every Provider has a Path Forward” white paper. The article states, “However, recent research from Leavitt Partners revealed that specialists have few, if any, APM options. Specialists from emergency medicine and audiology had no Medicare alternative payment model opportunities and respiratory therapists only had three models they can join.”

Washington, D.C., October 4, 2017 — Today the National Association of ACOs (NAACOS) and Leavitt Partners released the results from their first Annual ACO Survey in a Health Affairs article entitled “The 2017 Annual ACO Survey: What Do Current Trends Tell Us About The Future of Accountable Care.” Two-hundred and forty unique ACOs, representing one quarter of all known Medicare, Medicaid, and commercial ACOs, participated in the 2017 survey. Results provide an important view into the current state of ACOs as well as their plans for the future.

The findings shed light on ACOs’ participation in other Alternative Payment Models (APMs), common improvement activities, organizational and contract structures, and investments. Andrew Croshaw, CEO of Leavitt Partners, stated “With more than 32 million patients receiving care from ACOs nationwide, ACOs are now an important part of the American health care landscape, and the need to understand them better is becoming increasingly more important. The Annual ACO Survey provides one of the most comprehensive views into the growing ACO industry.”

Survey results indicate that ACOs are becoming more willing to take on financial risk; however, a successful transition to risk will only occur when they have the ability and infrastructure in place to take on and manage that risk. Clif Gaus, Sc.D., President and CEO of NAACOS said, “There are many opportunities to support the ACO movement, especially among policy makers and researchers. Everyone wants value-based care, but in order to do that we need to support, learn, and continuously improve. We’re all learning. Let’s do that together.”

Press contacts
National Association of ACOs: Clif Gaus at 202-640-1898 or cgaus@naacos.com
Leavitt Partners: Jordana Choucair, senior director of communications, 801.538.5082 or Jordana.Choucair@leavittpartners.com

David Muhlestein reacted to CMS’ announcement that the agency is setting a new direction the Center for Medicare and Medicaid Innovation (CMMI) for a Modern Healthcare article entitled “CMS champions innovation and competition while buoying value-based care.”

A RevCycleIntelligence article entitled “Specialists Lack Medicare Alternative Payment Model, MACRA Options” references the Leavitt Partners “Medicare Alternative Payment Models: Not Every Provider Has a Path Forward” white paper and links directly to the analysis. The article provides a synopsis of the analysis and notes the paper’s observations regarding three specialties (emergency medicine providers, audiologists, and respiratory) having limited alternative payment model options.

• HFMA article entitled “Increasing Physician Frustration with Lack of Models” references the Leavitt Partners “Medicare Alternative Payment Models: Not Every Provider Has a Path Forward” white paper and includes commentary from David Muhlestein. “It surprised me how some physicians have a number of options and others really don’t have options,” David said. “We know from those (models) that have been proposed that they are almost always specialty-focused because there is this recognition that there are so many specialists out there that are going to be subject to MACRA but there is not an APM option; they are stuck in MIPS for the time being,” Muhlestein said in an interview. The white paper was also highlighted in Rama Juturu – Healthcare Insights.

More than 86 million American adults have prediabetes. That number alone is astounding, but perhaps what is even more concerning is that 9 out of 10 people with prediabetes don’t know they have it. Considering that, in the absence of any health intervention, 15‒30 percent of people with prediabetes will develop type 2 diabetes within five years, effective preventive measures are needed to mitigate a serious public health crisis. The Centers for Disease Control and Prevention (CDC) is proactively responding to this potential problem by developing and promoting the National Diabetes Prevention Program (National DPP) lifestyle change program.

The Comprehensive Care for Joint Replacement (CJR) bundled payment model is a Centers for Medicare and Medicaid Services (CMS) initiative that is designed to incent hospitals to reduce the widespread cost variation in hip and knee replacements, and post-operative hospital readmissions throughout the United States. Originally announced in 2015 and revised in 2017, hospitals in
34 markets will be required to participate in the model, including being subject to downside risk, beginning January 1, 2018.

According to the National Institute on Drug Abuse and the CDC, in 2015 over 33,000 people died from opioid overdose in the United States, and in 2013 prescription opioid abuse cost the U.S. economy approximately $78.5 billion in costs related to health care, crime, and loss of productivity. Opioid abuse and the related overdose deaths […]

Given the well-publicized challenges with the individual market, carriers’ product development and pricing process for 2018 has been particularly difficult. In an effort to give insurers some reprieve, last week the Centers for Medicare and Medicaid Services extended the deadline for issuers to make changes to their rate filings from August 16 to September 5.[1]  However, […]

In the U.S., a person’s health status is impacted by a variety of factors such as race/ethnicity, disability status, socioeconomic status, age, gender, sexual orientation, geography, and more. These differences in society are linked to inequalities in health status that are referred to as health care disparities. The CDC defines health disparities as “preventable differences […]

 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.

Salt Lake City, June 23, 2017 — Leavitt Partners is pleased to announce that the firm will present 10 research posters and provide three presentations, supported by eleven researchers, at the AcademyHealth Annual Research Meeting (ARM) in New Orleans, LA June 25-27, 2017. The ARM is the premier forum for health services research, with a […]

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 […]

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 […]

Background The Quality Payment Program (QPP) under MACRA is now more than three months underway into the first payment year. However, there are still many nuances of the program, specifically under the multi-payer Advanced APM option, that payers —including commercial, Medicare Advantage, and Medicaid — and clinicians need to understand before they can begin collaborating, […]

Salt Lake City, May 1, 2017 – Today, Leavitt Partners released a new white paper, entitled “Post-Acute Care Optimization in a Value-Based Economy: Bridging the Gap Between Hospitals and Home.” The white paper addresses how the move to a value-based payment environment has necessitated that health systems tackle post-acute care spending and care management with […]

Bundle payment models, including the Bundled Payments for Care Improvement Initiative (BPCI), are an important part of the episode-based health care value transformation.  However, they are also under increased scrutiny, in part due to strong concerns among some Republicans regarding mandatory models as well as the idea that they do little to curb the volume […]

Six Characteristics of Successful Post-Acute Care (PAC) Value Networks Between 2001 and 2015 Medicare payments to post-acute care (PAC) providers more than doubled.[1] As such, PAC represents a growing opportunity for value-based entities such as accountable care organizations (ACOs), bundled-payment model participants, and medical groups to create savings in overall spend. Consider that five percent […]

Washington, D.C., April 12, 2017 – Leavitt Partners, a health care intelligence firm founded by former Governor and Secretary of the U.S. Department of Health and Human Services Mike Leavitt, announced today that Robert Horne will join Leavitt Partners as a senior director beginning on April 17, 2017. Based in Washington, D.C. Robert will advise […]

Salt Lake City, March 31, 2017 – Today, Leavitt Partners released an update to its December 2015 “MACRA: Quality Incentives, Provider Considerations, and the Path Forward” white paper. The new white paper, entitled “MACRA in 2017: Overview, Impact, and Strategic Considerations of the Quality Payment Program,” discusses some of the uncertainties that come with a […]

In April 2015, Congress enacted a law that alters the method by which physicians and other health care providers are paid for Medicare Part B services. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaced the sustainable growth rate formula with physician payments tied to quality. Providers must choose either significant performance-based payments […]

A RCM Answers article entitled “What’s Happening with Value Based Reimbursement in 2017” references the Leavitt Partners “Projected Growth of Accountable Care Organizations (2015)” white paper, stating that “In 2015, Leavitt Partners estimated almost 800 Medicare, Medicaid and Commercial ACOs covering over 23 million lives, and projected that number to grow to over 2600 covering […]

Health Affairs Blog published a Leavitt Partners piece entitled  “Changing Payments: The Landscape of Current CMS Payment Models Foreshadow Future Plans.” The blog outlines Historical Evolution of Medicare Payment Models and recent Medicare activities, as well as an analysis of portfolio programs and future directions.

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 […]

A PatientEngagementHIT article entitled “Bill Targets Patient Access to Pharmacy Care in Rural Areas” references the PAPCC press release, which was released on Monday. The article states: “’H.R. 592 will enable Medicare patients in medically underserved communities to better access important health care services that are often inaccessible to many Medicare beneficiaries, including health and […]

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 […]

An AIS article entitled “New Leavitt Report Shows MA Star Ratings Do Not Shrink Premiums” discusses the findings from the Leavitt Partners The Cost of Quality: How Star Ratings Can Influence Monthly Premiums in Medicare Advantage Plans David Muhlestein was also interviewed for the article and noted that the primary finding – higher-quality MA plans […]

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.

David Muhlestein discussed the future of MACRA for a Managed Care Magazine article entitled “What Does Trumpcare Mean for the Future of ACOs?” David said that MACRA was a bipartisan piece of legislation and that the ACO trend is much larger than the ACA and the CMS ACOs it spawned. The article also notes that […]

Leavitt Partners and Medicare Health Plans “The Cost of Quality: How Star Ratings Can Influence Monthly Premiums in Medicare Advantage Plans” paper was referenced in the Research Reports, Issue Briefs & Case Studies section of  Morning Consult’s Tuesday morning Health Brief. The paper’s scatterplot of star ratings and monthly premiums was featured as “Today’s Chart […]

David Muhlestein was featured in an Accountable Care News “Catching Up With” article. The article includes David’s responses to five ACO-related questions, including: How have accountable care organizations (ACOs) changed since their initiation? How do ACOs support the move toward value-based care? To what do you attribute the higher quality outcomes and increased financial savings […]

The Health Affairs DataWatch article entitled “Physician Consolidation: Rapid Movement From Small To Large Group Practices, 2013–15,” co-authored by David Muhlestein and Nate Smith, was referenced in an American Academy of Family Physicians article entitled “Small Practices Can Prosper in Era of Consolidation.” The article cites the study’s finding that the percent of physicians in […]

The April 2016 Health Affairs blog entitled “Accountable Care Organizations In 2016: Private And Public-Sector Growth And Dispersion,” co-authored by David Muhlestein, was referenced in a HealthPayerIntelligence article entitled “Where the Medicare Shared Savings Program May be Lacking.” The article notes that, “More than 400 accountable care organizations have been participating in the Medicare Shared […]

Health Affairs Blog published an analysis of the results for the ACOs participating in the Medicare Shared Savings Program (MSSP) and the Pioneer ACO Model during 2015, which was co-conducted by David Muhlestein. The blog, entitled “Medicare Accountable Care Organization Results For 2015: The Journey To Better Quality And Lower Costs Continues,” notes that the […]

On September 7, Health Affairs published a DataWatch paper entitled “Physician Consolidation: Rapid Movement From Small To Large Group Practices, 2013–15,” which observes the difference in consolidation patterns between specialists and primary care physicians, as well as between states. Leavitt Partners used data from Medicare Physician Compare to longitudinally examine the change in the proportion […]

A blog, co-authored by Governor Leavitt, was published in The Hill. The piece, entitled “Medicare’s bundled payment proposal: progress on health care payment reform,” examines CMS’ recently-proposed initiative to expand the use of bundled payments for Medicare beneficiaries who are hospitalized for bypass surgery, heart attack, or hip fracture. The authors note that while the […]

Health Affairs releases “Physician Consolidation: Rapid Movement From Small To Large Group Practices, 2013–15,” a DataWatch paper authored by Leavitt Partners researchers that examines the continuing trend of physician consolidation into larger group practices. Salt Lake City, September 8, 2016 — Today, Health Affairs published a DataWatch paper entitled “Physician Consolidation: Rapid Movement From Small To Large Group Practices, 2013–15,” […]

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 […]

Shawn Matheson provided insights into why bundled care programs for Risk & Insurance article entitled “Bundled Care’s Place in Workers’ Comp.” Shawn noted that, “With Medicare we’ve seen quick diffusion of bundled payments,” which will help private industry claims payers evaluate CMS challenges and successes as a base for additional program designs.

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 […]

Salt Lake City, UT – August 10, 2016 – Leavitt Partners and Forward Health Group have announced a collaboration to support physician groups and payers succeed in Comprehensive Primary Care Plus (CPC+), a payment initiative set forth by the Centers for Medicare and Medicaid Services (CMS). Primary care medical practices must apply for CPC+ by […]

By Melissa Porter & Shawn Matheson. On July 25, 2016, CMS announced a proposed rule to provide additional incentives for hospitals to provide higher quality care at a lower cost. The proposed rule seeks to increase coordination of care and decrease costs for heart attack and bypass surgery patients, creates a new Surgical Hip/Femur Fracture Treatment […]

Leavitt Partners “Ten Early Takeaways from the Medicare Shared Savings ACO Program” whitepaper was referenced in a RevCycleIntelligence article entitled “Medicare ACOs Reduce Healthcare Spending on Complex Patients.” The article includes two of the whitepapers data points: that only 26% of ACOs in the MSSP earned shared savings (which were highly concentrated among a handful […]

The American Journal of Managed Care published a Leavitt Partners paper – authored by David Muhlestein, Tianna Tu, Kate de Lisle, and Tom Merrill – entitled “Hospital Participation in ACOs Associated With Other Value-Based Program Improvement.” The paper analyzes whether hospital participation in an accountable care organization (ACO) is associated with a hospital’s quality and […]

A Becker’s ASC Review article entitled “High cost claimants account for 31% of large employers’ total spending & 9 other statistics” examines a recent American Health Policy Institute report that analyzed private and public sector spending from 26 large employers and then compared these figures to Leavitt Partners 2013 Medicare fee-for-service data.

On June 29, HHS announced its selection of oncology physician group practices and health insurance companies to participate in the Oncology Care model (OCM), a five-year bundled payment initiative that starts July 1 and will cover more than 3,200 oncologists and 155,000 Medicare beneficiaries. The program provides a $160 care management payment per beneficiary per […]

With CJR beginning last April and BPCI being extended for two more years until 2018, bundled payments have established themselves as CMS options for value-based care programs. Adoption looks to continue upward for future years, though, a potential mass adoption could take place if a favorable, future MACRA decision determines that bundled payments qualify for […]

Recently I had the opportunity to research CMS’ Oncology Care Model (OCM) bundle and to interview a number of c-suite individuals across oncology hospitals and clinics. Below please find eight summary thoughts. Difficulty of bundling oncology. Joint replacements (the focus of CMS’ new mandatory bundled payment program) have a clear beginning and end for the episode […]

Salt Lake City, June 16, 2016 — Leavitt Partners is pleased to announce that the firm will present nine research posters at the AcademyHealth Annual Research Meeting in Boston, MA June 26-28, 2016. The Annual Research Meeting (ARM) is the premier forum for health services research, with a program designed specifically for health services researchers, […]

A Hospitals and Health Network article entitled “All Roads Lead to Population Health Management” cited Leavitt Partners ACO data. The article notes: “Approximately 750 accountable care organizations are in operation today, covering some 23.5 million lives covered under Medicare, Medicaid and private insurers. Although still in the learning stages, many ACOs have had notable success […]

As a former primary care clinic manager and COO of a medical group engaged in value-based contracts, I was excited to see CMS’ announcement on Comprehensive Primary Care Plus (CPC+). I welcome this shift in Medicare primary care payments away from the quagmire of Fee-For Service (FFS) and into the higher ground of partial capitation, […]

Leavitt Partners releases “Comprehensive Primary Care Plus (CPC+): Transformational Physician Managed Care,” a white paper that assesses the recently announced CPC+ initiative and its implications on various segments of the health care industry.  Salt Lake City, June 7, 2016 — The “Comprehensive Primary Care Plus (CPC+): Transformational Physician Managed Care” white paper, released today, lays […]

While primary care is the foundation for effective population health management, traditional reimbursement structures under fee-for-service (FFS) do not facilitate the delivery of high-quality primary care. The April 11, 2016 announcement of the Comprehensive Primary Care Plus (CPC+) program by the Centers for Medicare and Medicaid Services (CMS) marked a sweeping move to transform the […]

A New York Times article entitled “ I.R.S. Ruling Is Obstacle to Health Care Networks Promoted by Obama” cited Leavitt Partners ACO covered lives data. The article states, “The new entities, which now cover more than 28 million people, according to Leavitt Partners, a health care consulting firm, help manage care for Medicare beneficiaries, for people with employer-sponsored insurance and for consumers who buy coverage through online marketplaces under the Affordable Care Act.”

Leavitt Partners “Ten Early Takeaways from the Medicare Shared Savings ACO Program” whitepaper was highlighted in a RevCycleIntelligence article entitled “Mixed Results for MSSP Accountable Care Organization Saving.” The article extensively quotes data from the whitepaper and notes that while the transition to value-based care will “require patients and culture and practice-related adjustments over a generation…the numbers from this report do show that the MSSP experience pays off in earned savings and better quality over time.”

David Muhlestein and Douglas Hervey were interviewed about key findings from the “Ten Early Takeaways from the Medicare Shared Savings ACO Program” for a Managed Healthcare Executive article entitled “Lessons learned from MSSP ACOs: What execs should know.” David and Douglas highlighted a few providers who have experienced success and also weighed-in on why more ACOs aren’t saving money.

On April 26, 2016, CMS released final rules for Medicaid managed care and CHIP, marking the first revamp of these rules in over 10 years. Currently, 39 states and D.C. rely on managed care to provide services to all or a portion of their Medicaid beneficiaries, and that number is growing. The use of managed […]

Risk adjustment in its simplest form is a process that transfers funds from issuers with relatively lower risk enrollees to issuers with relatively higher risk enrollees to protect against adverse selection. However, the mechanics behind this process are quite complex and from its inception there was a lot of uncertainty and debate about how effective […]

David Muhlestein commented on the financial risk for Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) in a Modern Healthcare article entitled, “Docs face stark choices under new Medicare pay proposal.” David said, “This really is a defining piece of legislation for how we pay for healthcare in America. It changes the expectation of what practicing medicine is. It’s increasing the scope of responsibility for physicians.”

Leavitt Partners recent “Ten Early Takeaways from the Medicare Shared Savings ACO Program” whitepaper was highlighted in a FierceHealthFinance article, entitled “Emerging quality and savings trends outline challenges and promise of ACO model.” The article notes that “In order to get a read on the effectiveness and ultimate viability of transforming an organization into an ACO, Leavitt combined the public performance data provided by the Centers for Medicare & Medicaid Services (CMS) with information from its own proprietary database” and briefly describes three of the emerging trends.

Becker’s Hospital Review featured findings from Leavitt Partners recent “Ten Early Takeaways from the Medicare Shared Savings ACO Program.” The article, entitled “MSSP Market Landscape and Trends: 10 Things to Know,” briefly describes each of the paper’s 10 trends about what has and has not worked for the MSSP program thus far.

David Muhlestein shared his insight on how the CMS Next Generation ACO program resembles how Medicare Advantage (MA) plans get paid for a Managed Care Magazine article entitled “Medicare Advantage’s Influence Felt in Accountable Care Model.” In David’s view, CMS is more interested in creating a buffet of risk-bearing programs than in blurring the differences between MA and its ACOs.. He said, “Medicare is now being viewed as a policy lever whereby payment models can be used to influence the broader delivery system. And that is a pretty important change. Moving providers and beneficiaries away from fee for service and into a population-focused system where providers assume more risk is the focus of that change.”

Amid a firestorm of protest, the Obama administration announced a new test model for how it will pay for Medicare Part B drugs. According to the administration, this move is in line with recent changes to payment methodologies from the Centers for Medicare and Medicaid Services (CMS) in an effort to curb escalating medical spend […]

Last October I wrote a blog examining the average number of days that opioids were prescribed per medicare beneficiary at the state level. There is continual interest in understanding and reducing the abuse of prescription pain medicines.1 Use of opioids to manage pain has been increasing steadily since the early 90s,2 and increased use is […]

With the Comprehensive Care for Joint Replacement (CJR) program starting April 1, approximately 800 hospitals in 67 locations will be entering a mandatory bundled payments program, testing their competency against risk-based payment and hoping to achieve savings. Many wonder how these hospitals will perform under CJR for bundled payment joint replacement surgeries, as it will […]

CMS’ January 11 announcement of the new and renewing Medicare ACO participants indicated both an increase in the number of ACOs and ACO covered lives. The now 477 CMS ACOs that are participating in one of four CMS models—the Medicare Shared Savings Program (MSSP), Pioneer, Next Generation ACO (NGACO), and Comprehensive ESRD Care (CEC) —are currently responsible for 8.9 million lives, up […]

As the number of CMS ACOs continues to increase, the future of accountable care appears to be positive. With a net increase of 121 ACOs in January 2016, the now 477 CMS ACOs represent 49 states and 8.9 million lives. A number of the established ACOs have also opted for more risk. Seven former Pioneer […]

On Friday, the Centers for Medicare and Medicaid Services (CMS) announced their proposed Medicare rate adjustments. Estimates forecast a 3.5% increase for Medicare Advantage plans after adjusting for coding practices. CMS also intends to “improve payment precision and encourage quality” with the possibility of some changes to the star rating system. The proposed changes represent […]

An EHR Intelligence article entitled “Accountable Care Organization EHR, HIE Use by the Numbers” referred to the Leavitt Partners “Project Growth of Accountable Care Organizations” white paper. The article notes that “According to Leavitt Partners, the preceding year closed with 782 ACOs in operation and the number of lives covered by ACOs totaled an estimated 23.2 million. What’s more, the federal government’s commitment to value-based reimbursement — such as Medicare Access and CHIP Reauthorization Act (MACRA) — is fueling prediction of 500-percent growth in lives covered by ACOs by 2020.”

On November 16, 2015, the Centers for Medicare and Medicaid Services (CMS) finalized the Comprehensive Care for Joint Replacement (CJR) model, its first mandatory bundled payment initiative. The final rule made several major changes to the CJR program, including that the program’s start date would be delayed to April 1, 2016 (a four-month delay).

Leavitt Partners releases “The Coming of Mandatory Bundled Care: The Comprehensive Care for Joint Replacement Program (CJR),” a whitepaper detailing the new CJR program and the implications it will have on industry stakeholders. Salt Lake City, UT – January 27, 2016 – Leavitt Partners today announced the release of a new whitepaper, “The Coming of […]

Leavitt Partners “Projected Growth of Accountable Care Organizations” whitepaper was referenced in a RevCycleIntelligence article entitled “CMS Says 121 New Medicare ACO Participants Advance Quality.” The article includes the number of lives covered by ACOs, and notes ““Value-based care delivery models designed to improve the financial and quality outcomes of health care organizations have been the focus of the health care discussion for several years.”

David Muhlestein provided commentary on the newest Medicare ACO participants for a Modern Healthcare article entitled, “New Medicare ACOs include first ‘Next Generation’ cohort.” David noted that “ACOs are moving toward risk, but they are not necessarily moving as fast as some people predicted,” and that it will be a couple of years before the majority of providers move to such agreements. “It’s really hard to move toward risk-bearing because it’s not just a payment model. It’s a transition in how you’re delivering care,” he said.

Clay Alspach joins Leavitt Partners Salt Lake City, January 7, 2016 —Leavitt Partners, a health care intelligence firm founded by former Governor and Secretary of the U.S. Department of Health and Human Services Mike Leavitt, announced today that Clay Alspach, Chief Health Counsel for Chairman Fred Upton of the U.S. House of Representatives Energy and […]

Leavitt Partners releases “Projected Growth of Accountable Care Organizations,” a whitepaper detailing ACO growth projections under four possible future scenarios. Salt Lake City, UT – December 23, 2015 – Leavitt Partners today announced the release of a new whitepaper, “Projected Growth of Accountable Care Organizations,” which forecasts the growth of the ACO model under possible […]

In April 2015, a divided Congress almost unanimously passed a landmark law that will permanently change the way physicians and other health care providers are paid for Medicare services. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaced the sustainable growth rate formula with physician payments tied to quality.

Health Affairs releases “How Might Proposed Mergers Impact State Insurance Markets?” blog containing a state-by-state landscape analysis. Salt Lake City, December [2], 2015 — With recent news of the proposed Aetna/Humana, Anthem/Cigna, and Centene/Health Net mergers, a number of stakeholders have raised questions about how consolidation impacts health care markets’  competitiveness. For these proposed deals, […]

Last week CMS finalized rules for the Comprehensive Care for Joint Replacement (CJR) bundle, which goes into effect April 1, 2016 and makes certain hospitals financially at risk for the entire episode of care of a Lower Extremity Joint Replacement (LEJR) patient. Leavitt Partners previously issued a policy brief on the initiative. I believe this […]

Last month CMS published a request for comment regarding a proposed change in how services provided by an Indian Health Service (IHS) or Tribal facility are reimbursed under Medicaid. This proposed change could represent a significant shift in reimbursement policy for many states, IHS, Tribes and providers. If it moves forward, this change will align […]

David Muhlestein provided insight on CMS lowering 65 Medicare ACOs’ financial awards for 2014 because of quality performance in a recent Modern Healthcare article entitled “Medicare ACOs lost $41 million to poor quality performance.” According to David, none of the ACO programs’ top financial performers ranked in the 90th percentile for quality nationally. Further, none of the other approximately 260 ACOs that reported performance measures for 2014 ranked in the top 90th percentile (Article here). The article was also referenced in a California Healthline article entitled, “CMS Reduced Financial Awards for 65 ACOs Due to Quality Scores” (Article here).

Over the last several years, we’ve heard countless times about how health care spending in the U.S. has become unsustainable. Despite slowed health care spending growth over the past few years, growth is expected to pick up for future years. To put the magnitude of the expected growth into context, it’s anticipated that if current […]

Becker’s Hospital Review published a piece authored by David Muhlestein. The article, entitled “3 keys for Medicare ACO survival”, examines a few important observations regarding ACO growth and offers three keys that CMS must address to maintain the viability of the Medicare ACO program.

Leavitt Partners ACO intelligence was referenced in a Becker’s Hospital Review article highlighting a variety of Medicare and commercial payer ACOs. The article, entitled “100 accountable care organizations to know | 2015” states that “The estimated number of ACOs in public and private programs tops 740, according to Leavitt Partners, and if trends continue, ACOs have the potential to cover at least 75 million lives.”

David Muhlestein was interviewed for a Kaiser Health News article entitled “Medicare Yet To Save Money Through Heralded Medical Payment Model”. David commented on the difficulties implementing the program, specifically noting that, “Because Medicare sets its expectations based on national spending averages it’s really hard to save money in some parts of the country. We’ve talked to ACOs that have joined the program, started to make changes and decided that it’s really too much work right now.”

David Muhlestein was interviewed for a Kaiser Health News article entitled “Medicare Yet To Save Money Through Heralded Medical Payment Model”. David commented on the difficulties implementing the program, specifically noting that, “Because Medicare sets its expectations based on national spending averages it’s really hard to save money in some parts of the country. We’ve talked to ACOs that have joined the program, started to make changes and decided that it’s really too much work right now.”

The CMS ACO programs have been the subject of much debate and analysis among those who monitor and evaluate health care payment and delivery reform efforts. Much of the focus of this debate has been on evaluating the cost and quality metrics that have resulted from the Pioneer and MSSP models deployed by CMS. Some […]

Recently, the Centers for Medicare and Medicaid Services (CMS) announced that more providers have decided to assume financial risk under Phase 2 of the Bundled Payments for Care Improvement (BPCI) program. Launched in January 2013, the BPCI Initiative has offered providers an opportunity to pursue 48 episodes of care within four different types of bundled […]

We are leaving a period of horizontal payer M&A, focused on nascent, highly-strategic transactions, and entering a period where faster and more pervasive consolidation is likely. This should not surprise anyone. The virtual commoditization of traditional payer functions (medical management, lives aggregation, administration, network management, etc.) through the passage of the Affordable Care Act and […]

Many experts believe that primary care can be the solution to our country’s health care woes. Primary care clinicians, in many respects, ensure our patients get the right care, in the right place, by the appropriate practitioner, in a manner agreeable to the patient. Past research on our health care system also shows that areas with […]

Thousands of communities throughout the United States have been identified by the Department of Health and Human Services (HHS) as underserved. Given the designation of a health professional shortage area (HPSA), medically underserved area (MUA), or medically underserved population (MUP), the communities and their individual members struggle to address health care needs. The designations given […]

Academic Medical Centers (AMCs) are a vital part of the U.S. health care system.  They train doctors, find new treatments and cures, and in many cases, care for the sickest and most complex patients at their facilities. AMCs also provide important community services, and are critical to America’s safety net. AMCs in today’s world of […]

We write to the governors and legislative leadership of 34 states with the aspiration of using our collective experience as former officials from the Department of Health and Human Services (HHS) to share an analysis that may be helpful in anticipating options ahead of the King v. Burwell court ruling. Within the next two weeks, […]

Variability in Prostate-Specific Antigen (PSA) Testing Across the United States During the past few years the Centers for Medicare & Medicaid Services (CMS) has increasingly been willing to release data that allows analysts to study treatment patterns for individual physicians. This has been extensively covered by the media, particularly as it relates to high-paid physicians. […]

One of the last projects I worked on before leaving the Department of Health and Human Services (HHS) was to inventory all the quality measures used by the reporting agencies, including NIH, CMS, CDC, and others. It was the first attempt and what our team found was startling: HHS was using nearly 900 different measures, […]

The SGR repeal passed on April 14th streamlines existing incentive programs and includes enticing new incentives for value-based payment arrangements. While providers may have hoped for more favorable rate increases, they welcome an alternative to the looming uncertainty of the SGR formula The legislation provides some long-term stability and averts a reoccurring crisis, in this […]

For nearly five years, Leavitt Partners has led the nation in tracking and analyzing the growth and geographic dispersion of Medicare, Medicaid and commercially formed Accountable Care Organizations. Newly released numbers through the Health Affairs Blog note that: 744 ACOs now exist in all 50 states and cover 23.5 million lives 132 different health insurance […]

Leavitt Partners has released updated counts on the growth of ACOs through the Health Affairs Blog. The blog notes that through the end of January 2015, 744 ACOs now exist in all 50 states and cover 23.5 million. While Medicare ACOs play an important role, 132 different health insurance payers now have at least one accountable care contract indicating how broadly the model has expanded. Leavitt Partners has also projected the most likely growth of ACOs and estimate that 72 million people could be covered by ACO contracts by 2020. (Blog here) The blog was reported on by RevCycleIntellignece

Over two years ago, Medicare launched the Bundled Payments for Care Improvement (BPCI) Initiative which offered four voluntary bundled payment models wherein providers could participate. BPCI has generated more participants than the Medicare Shared Savings Program (MSSP) and the Pioneer ACO Model and has grown substantially over time. In March 2013, the program only had […]

As technology continues its rapid advance, telemedicine is becoming much more relevant as a means of expanding care delivery options.  While telemedicine is limited in its scope for certain services, it continues to evolve as a key component in primary care as organizations seek to more efficiently and effectively manage the care of their patient […]

Andrew Croshaw was interviewed for a Modern Healthcare article entitled “Will new Medicare ACO model enable providers to truly manage care?” According to Andrew, the new ACO model is a significant development for the transition to value-based care. He said, “You’re essentially saying to the market, ‘This is where we are moving from a methodology and payment standpoint.'”

Sunday, March 15: Andrew Croshaw was interviewed for a Modern Healthcare article entitled “Will new Medicare ACO model enable providers to truly manage care?” According to Andrew, the new ACO model is a significant development for the transition to value-based care. He said, “You’re essentially saying to the market, ‘This is where we are moving from a methodology and payment standpoint.’”

The Rise of a GOP Option In 2014, GOP leadership took a decisive step to shape the repeal and replace philosophy through the introduction of the Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act.  The legislation, co-authored by Senators Richard Burr (R-N.C.), Tom Coburn, M.D. (R-Okla.), and Orrin Hatch (R-Utah), was deemed as “a legislative […]

This past week saw several announcements from some very significant groups regarding the shift toward value-based payment. First, Secretary Burwell announced that HHS would move 30% of its total spending in Medicare to value-based payments by 2016 and 50% by 2018 through models like ACOs and bundled payments. Soon after, a coalition of health care […]

Leavitt Partners is acting as an implementation partner to the Health Care Transformation Task Force (HCTTF), an alliance of major health systems, insurers, and other industry players committed to putting 75% of its business into “value-based payment arrangements” by 2020.  The HCTTF was launched on Wednesday, just two days after HHS announced its goal of […]

Leavitt Partners is acting as an implementation partner to the Health Care Transformation Task Force (HCTTF), an alliance of major health systems, insurers, and other industry players committed to putting 75% of its business into “value-based payment arrangements” by 2020.  The HCTTF was launched on Wednesday, just two days after HHS announced its goal of […]

Governor Leavitt commented on the announcement made by HHS on Monday regarding its goal of shifting Medicare payments in an AP article entitled “Gov’t to overhaul Medicare payments to doctors, hospitals”.  “Transforming the health care system requires transforming Medicare,” said former HHS Secretary Mike Leavitt. “The fee-for-service payment system is at the root of much […]

A Kaiser Health News article entitled “HHS Pledges To Quicken Pace Toward Quality-Based Medicare Payments” referenced Leavitt Partners ACO intelligence, noting that the firm currently counts 317 commercial ACOs and 40 in the Medicaid program.

The biggest challenge to the Patient Protection and Affordable Care Act (“ACA”) isn’t a Republican controlled Congress, public-opinion, or a government website glitch. It is the Supreme Court. The Court will soon decide whether millions of consumers residing in the 34 states using the federally-facilitated insurance marketplace (FFM) will become ineligible for subsidized coverage.

For states looking to ease in step-by-step with State-Based Marketplaces, the Supported State-Based Marketplace appears to be that practical option.

Known as private, nonprofit organizations, CHCs have grown up over the years, and aren’t just considered the safety-net option for care anymore.

Leavitt Partners ACO intelligence was reference in a Milwaukee Journal Sentinel article entitled “Medicare experiment rewards better health care at a lower cost”. The article notes that an additional 287 ACOs have been set up to contract with health insurers and employers.

Melinda Beck, a Health & Science Reporter for The Wall Street Journal, featured a comment from David Muhlestein in a “Market Talk” item regarding the latest Pioneer ACO defections. According to David, the departure of 4 more hospital systems from the program isn’t surprising given the longstanding gripes about its structure. David said the departures could spur Medicare to re-evaluate the Pioneer model, although they could make it look better, and notes with the less-successful hospitals gone, a higher percentage of those which remain may be able to achieve savings.

Accountable Care Organizations (ACOs) are financially accountable for the cost and quality outcomes of a population, in many cases, even when services are delivered by a separate health care organization. Because of this, ACOs have a vested interest to coordinate care across the entire care continuum. To influence outcomes beyond their doors, ACOs utilize care coordinators, HIT tools, and form partnerships with […]

Hospitals and physicians have become more focused on the implementation of care coordination tactics among their organizational entities.

With an increased focus on health care and Medicaid expansion, states are looking for ways to increase the efficiency and quality of the program.

Personalized medicine is a rapidly advancing field of that is informed by each person’s unique clinical, genetic, genomic, and environmental information.

In an effort to tackle care coordination and cost challenges associated with many of the most vulnerable and needy patients, states around the country are experimenting with managed care and dual eligible initiatives.

Payers are increasingly focused on readmission rates and holding hospitals accountable through the use of financial penalties.

David Muhlestein weighed-in on a recent Health Affairs survey that found that ACOs have given little attention to surgery in the early years of the Medicare program. According to David, part of the reason is that working with surgeons and specialists aren’t at the top of priority lists. Another reason is that it’s hard for an ACO to figure out how to share savings with specialists like surgeons.

Leavitt Partners releases “Variation in Health Care Provider Concentration: A National Visualization”, which assesses provider supply within the United States

As industry confusion continues over the future of ICD-10, it is important to figure out what is best for your individual organization.

To combat physician shortage, various programs, hospitals and states are offering incentives to encourage students into certain specialties.

The combination of ACOs and online marketplaces could represent a real win for consumers when shopping for health insurance coverage.

Cost and quality metrics are integral parts of the accountable care movement; this makes attribution essential to successful reporting.

Economic growth is an important assumption when predicting the likely increase of value-based payment arrangements.

No one disputes the revolutionary power HIT can have on the practice of medicine. The question is whether HIT will have a more powerful effect on the needle or the haystack.

David Muhlestein, Director of Research at Leavitt Partners, published another piece in the Health Affairs Blog on the results from the early Medicare Accountable Care Organizations (ACOs). The article examines current ACOs, CMS’s perspective, “ACOs-in-waiting,” and the future of the shared savings program.

Building upon Leavitt Partners continuing work around the accountable care landscape, Director of Research David Muhlestein examines how the movement has grown and points to what industry observers should watch for in 2014. The piece takes a look at what factors might affect the growth rate of the ACO movement in 2014, including the forthcoming release of first year results for the early Medicare Shared Savings Plan ACOs, the impact of political changes on both a federal and state level and the importance of consumer preference affecting ACO growth.

Paul Gardner, Senior Analyst at Leavitt Partners, underscores the importance for ACOs to not only produce shared savings but to also meet quality measures.

Scott Hammer, Senior Associate at Leavitt Partners, shares how Medicare’s Value-based Purchasing Program incentives hospitals to make improvements in the delivery of quality-based care.

Physician practices have the potential to encourage hospitals to compete on price and quality for the allegiance of physician sponsored ACOs

Gov. Leavitt was interviewed for an article in The Huffington Post that discussed how unresolved technical problems on HealthCare.gov could result in patients finding out at the doctor’s office that they actually did not successfully use the website to sign up for health insurance. Gov. Leavitt compared this scenario to enrollees finding out their benefits weren’t in place under Medicare Part D and asserted that “There’s an obligation to make certain that people have not been seriously disadvantaged in their health by this.”

Going forward hospitals will able to train certified application counselors to assist patients with exchange enrollment.

Matthew Petersen, Analyst at Leavitt Partners, sheds light on an often overlooked provision in the Affordable Care Act, Pediatric Accountable Care Organization Demonstration Projects.

A chart from the “Growth and Dispersion of Accountable Care Organizations: August 2013 Update”, authored by Matthew Petersen, David Muhlestein, and Paul Gardner, was cited in an AcademyHealth Blog. The chart compares the Medicare vs. non-Medicare growth of ACOs over time.

What is the cost of providing care and why does that matter as providers assume greater risk?

David Muhlestein, recently wrote an article for the Health Affairs blog that describes a recent slowdown in the growth of ACOs. Since the last announcement of Medicare Shared Savings Program participants in January there have only been 35 new ACOs. Payer delays, such as the yearly application cycle for the Shared Savings Program is likely partly responsible for the delay. Another reason is that many of the most innovative and forward thinking provider organizations are already participating in ACOs. Since ACO results have been inconclusive so far, many organizations are likely waiting for a proven model to follow.

In a recent POLITICO article examining the parallels between Medicare Part D and Obamacare rollout, Gov. Leavitt noted that “if it gets fixed, six months from now it will be remembered as a rocky episode and nothing more…otherwise, “it will brand Obamacare in a very harsh light.”

Tara Gunther, Director of Provider Services, offers her insights on the Medicare Payment Advisory Commission (MedPAC) 2013 report.

Many have said, “If you have seen one ACO, you have seen one ACO”. David Muhlestein, Director of Research at Leavitt Partners, characterizes four central functions of an accountable care organization.

Gov. Leavitt joined MSNC’s The Cycle earlier today and spoke about his experience overseeing the Medicare Part D rollout, and what Obamacare officials can learn from it.

Christian Pena, Senior Analyst at Leavitt Partners, explains why ACO technological innovations may ultimately have a larger impact on health care than the ACOs themselves.

Paul Gardner, Senior Analyst at Leavitt Partners, shares ways in which ACOs can effectively incentivize high-performing providers within a shared savings contracting arrangement.

When patients and physicians apply shared-decision making, quality and satisfaction go up while costs go down.

David Muhlestein is quoted in an hfma article examining if ACOs will decrease patient outcomes and decrease costs. He cautioned that spillover savings identified in the Massachusetts study are less likely to occur with Medicare ACOs because of their relative size.

In Finding Allies, Building Alliances, Mike Leavitt and Rich McKeown explain how a well chosen network can become a powerful alliance. They
provide a framework of 8 elements that will help any leader foster and maintain an effective, productive venture. Whether you’re launching a new partnership, or rehabilitating one already in progress, Finding Allies, Building Alliances will help you find workable solutions to the most
complex problems and boost competitiveness and resilience. Learn more about the book by visiting FindingAllies.com

On August 19, US News & World Report published an article on how ACOs are forcing doctors and other health care professionals to rethink how they deliver care in an effort to improve coordination and quality while lowering costs. Andrew Croshaw contributed to the article, offering insight into overall ACO trends and Medicare ACO performance and quality measures.

Physician and hospital organizations are evaluating new delivery models that offer the prospect of materially improving the quality and financial viability of care delivery in rural communities.

The Leavitt Partners Center for Accountable Care Intelligence releases new white paper entitled “Growth and Dispersion of Accountable Care Organizations: August 2013 Update” Salt Lake City, August 15, 2013 — Drawing from an ongoing study by Leavitt Partners, The Center for Accountable Care Intelligence has released an ‘August 2013 Update’ to the previously acclaimed white […]

On July 21, the Fiscal Times published a story entitled “Obamacare Glitch No. One: Verifying Eligibility”. Dan Schuyler noted that one of the greatest challenges regarding enrolled would be getting people who have had little interaction with the health care system to sign up. He also warned about troubles surrounding Medicare eligibility.

Douglas Hervey, Coordinator of ACO research at Leavitt Partners, outlines six key takeaways from Medicare’s first year report on thier Shared Savings Program.

Mike Leavitt published an article in the Washington Post comparing the implementation of the Accountable Care Act with Part D of Medicare, which he oversaw as Secretary of Human and Health Services under the Bush Administration. Mike Leavitt provides insight from the challenges and obstacles his department faced with citizen education, technology, subsidies, and finger-pointing.

As many as nine of 32 Pioneer ACOs may exit the program and at least four have started to notify providers. This begs the question, “Is it time to panic?” The answer, “No.”

On June 25, Governor Leavitt co-moderated a panel presentation on the status of implementation of the new health insurance marketplace.  During the event, Governor Leavitt shared lessons learned from implementing Medicare Part D and discussed how those insights may be applied to the implementation of the new health insurance marketplaces.

Douglas Hervey, Coordinator of ACO Research at Leavitt Partners, discusses the four critical components of successful ACOs.

SALT LAKE CITY, (Feb. 20, 2013) — Leavitt Partners estimates 428 Accountable Care Organizations (ACOs) now exist in 49 states. ACOs have expanded dramatically, more than doubling in number since the start of 2011. Physician groups are now the largest backers of ACOs, with hospital systems a close second. Delaware is the only state in the […]

David Smith, Analyst at Leavitt Partners, discusses the Congressional Budget Office’s (CBO) annual budget and economic outlook for 2013-2023.

Leavitt Partners has launched LP Health Speakers, an experienced and knowledgeable selection of health care visionaries and thought leaders who are available to deliver keynote addresses, moderate and participate in panels, speak at retreats, facilitate strategic discussions and conferences, and brief senior executive teams. The firm is pleased to feature more than a dozen health care […]

SALT LAKE CITY, (November 29, 2012) — A comprehensive and cutting-edge report co-authored by Leavitt Partners and KLAS Research shares detailed information about the structure, maturity, partnerships, practice and payment arrangements of Accountable Care Organizations (ACOs) throughout the country. The report, which represents the culmination of months of survey research and analysis, is based on a […]

Giving patients more control over, and visibility into, health care spending decisions, will contribute to a better functioning health care marketplace.

All Payer Claims Database’s (APCD) provide researchers a comprehensive picture of health care spending and utilization within a state. This collection of data will help recognize trends, and identify providers who offer the best value.

SALT LAKE CITY, (Oct. 30, 2012) — With the 2012 election a week away, Leavitt Partners today released analysis that shows the critical impact the elections will have on the implementation of the Affordable Care Act. Hanging in the balance is the execution of federal health reform as determined by the White House, Congress, statehouses and America’s private […]

The creation of accountable care organizations happens to be one of the most talked about provisions in PPACA, but are they a big deal? Yes!

Accountable Care Organizations, commonly referred to as ACOs, now stretch across 45 U.S. states and the District of Columbia. In total, 221 ACOs have been identified — a 38 percent increase compared to those identified just six months ago. ACO activity in the private sector outnumbers the government sector by a factor of four to […]

SALT LAKE CITY, (May 31, 2012) — In anticipation of the forthcoming Supreme Court decision on the federal health reform law, Leavitt Partners has analyzed how various rulings by the court, when combined with 2012 election results for the White House and Congress, may impact the future of American health care. The analysis draws upon the […]

David Muhlestein — Analyst at Leavitt Partners — describes and compares the reasons why health insurance exchanges will be disruptive to our current way of delivering health insurance. The Patient Protection and Affordable Care Act (ACA), considered the most important piece of federal health care legislation since the creation of Medicare and Medicaid[i], has been […]

Leavitt Partners FuturePanel™ member and senior advisor Charlene Frizzera will speak at the 2012 LTC 100 Leadership and Strategy Conference being held May 5-8 at the Ritz-Carlton Naples Beach, Florida. The conference will focus on affirming skilled nursing’s role in the evolving health care system. LTC 100 is the premier conference for executives in skilled […]

Salt Lake City (Feb. 28, 2012) — Leavitt Partners today announced the formation of Health Intelligence Partners™, a member-based, health care executive collaboration. The collaboration brings together industry leaders and policy experts to participate in tailor-made health care intelligence activities that give members an informed perspective on the likely future of health care. Skillfully executed national surveys, […]

Leavitt Partners’ David Muhlestein shares his view of why Medicare patients lack the necessary resources to find care to meet their needs. He argues that Medicare’s Hospital Compare is not sufficient and shares what he believes needs to change to create adequate health care quality reporting. It’s a common problem. While trying to complete a […]

Leavitt Partners has created FuturePanel™, an authoritative group of health care thought leaders who inform, refine and guide the health care intelligence shared by the firm. FuturePanel members include former senior executives from the Centers for Medicare and Medicaid Services, national leaders in health information technology, veterans of state-level health care policy, clinical experts and […]

Leavitt Partners’ Center for ACO Intelligence, which tracks national and regional trends related to ACOs and other emerging care delivery systems, released a white paper today entitled Growth and Dispersion of Accountable Care Organizations. This is the first report of its kind regarding the types and locations of ACOs. The report provides data-driven insights into the evolution […]

Following the Patient Protection and Affordable Care Act’s emphasis on Accountable Care Organizations (ACOs) and the announcement of the Medicare Shared Savings Program, an increased interest has emerged among providers and payers to create ACOs. To date, little has been published regarding the types and locations of organizations adopting principles of accountable care. As part […]

Dr. John Nelson outlines how pay cuts will likely widen gap between smaller and larger hospitals. An interesting article suggests that the disparity between affluent hospitals and those that are struggling may widen under health system reform.1 The article points out in a credible fashion why this may be so. Smaller hospitals that are less […]

The Standard & Poor’s rating agency announced Friday that it has downgraded the U.S. credit rating to AA+ from its top rank of AAA.  Andrew Croshaw shares his thoughts. Much has been written about the appropriateness of Friday’s U.S. credit downgrade by Standard and Poor’s from AAA to AA+. Some argue it was politically motivated, […]

Michael O. Leavitt is a member of the Deseret News Editorial Advisory Board. The following op-ed was published in the Deseret News July 17th, 2011. The nation’s governors met for their annual meeting in Salt Lake City this week. Governors enjoy this opportunity to learn from and occasionally commiserate with peers dealing with similar challenges. […]

When a production line manufactures a defective widget, the foreman has a significant decision to make: whether to repair the damaged widget or throw it away and start over.  In health care, that luxury does not exist.  When a medical error occurs (i.e., one that results in harm to a patient), the damage caused must […]

Republished from July 15, 2010 Information technology is a funny thing. It can make sharing information in a variety of formats faster, more convenient, and more accurate. However, the success of any technological advancement is entirely dependent on the rate at which its use is adopted by the intended users. And adoption depends on a […]

Michael O. Leavitt was the secretary of the U.S. Department of Health and Human Services (HHS) from 2005 to 2009. Thomas Barker is a partner with Foley Hoag, former acting general counsel for HHS and general counsel to the Centers for Medicare and Medicaid Services. Washington Times Years ago, Washington was rocked by revelations that […]

By Lauren Kelley. As the House prepares to vote on the Continuing Resolution for the FY2011 Federal budget, and as Congress reviews President Obama’s FY2012 budget proposal, I’d like to share my perspective on Community Health Centers. Currently, the House is considering a $1.3 billion reduction in Federal funding for Community Health Centers in FY2011. […]

Michael O. Leavitt is the newest member of the Deseret News Editorial Advisory Board. On Tuesday, Jan. 18, 2011 the following column was published by Desnews.com. On Wednesday, Jan. 19, 2011 the U.S. House of Representatives voted to repeal PPACA. By Michael O. Leavitt On Wednesday, it appears the U.S. House of Representatives will vote […]

Cancer is one of the most significant health care problems that our society faces, impacting millions of citizens in the United States. It is the second leading cause of death in the country. According to the American Cancer Society, there will be over 1.5 million new cancer diagnoses and over 550,000 deaths attributable to cancer […]

The Moment of Truth, the Report of the National Commission on Fiscal Responsibility and Reform (popularly referred to as “the Debt Commission”),* gets high marks for sounding the alarm about the “crushing debt burden” that threatens the chances of our children and grandchildren to have a better life than we currently enjoy (and perhaps, take […]

Medicaid is a paradox. It is routinely considered to be too generous and too stingy; both unreliable and indispensable; and is a program for the poor, although not all people who are eligible are poor and not all poor people are eligible (though this latter point will change significantly in 2014). The Obama Administration is […]

While the Patient Protection and Affordable Care Act (PPACA) is obviously a sweeping piece of legislation, there is a law more powerful to which even the PPACA is subject—the law of unintended consequences (LUC). Economists have warned about unintended consequences for centuries. But we don’t really need to consult economists on this matter as we […]

By Dennis G. Smith The six month anniversary of enactment of the Patient Protection and Affordable Care Act (PPACA) coincided with the last full week of the major league baseball regular season. The intersection of these occasions presents an opportune time to review the appropriate role of an umpire. An umpire is needed to fairly […]

Get ready, America, for what you will need to know in order to how to spend your share of nearly $100 billion in 2014 under the Patient Protection and Affordable Care Act (PPACA). Let’s translate the “want ad” above by following the money: PAC means premium assistance credit. These credits are new entitlement subsidies that […]

Whether a coincidence or not, the Kaiser Family Foundation (KFF) and the Health Research and Educational Trust (HRET) released their annual survey of employer-sponsored health benefits just in time for the Labor Day weekend. If it were a hotdog, it would come with “the works.” Great gobs of data ooze from more than 200 pages. […]

By Dennis G. Smith Dennis G. Smith, Managing Director of Leavitt Partners’ Medicaid Practice, explains the past, present, and future of Medicaid expansion and who it concerns. Before joining Leavitt Partners Dennis was Director of the Center for Medicaid and State Operations (CMSO) at the Centers for Medicare and Medicaid Services.  

How many times has this famous beginning of Gertrude Stein’s stanza of her poem, “Sacred Emily,” been repeated in the nearly 100 years since it was published in 1913? While numerous interpretations have been offered regarding its meaning, it seems that Stein was not merely explaining the obvious, she was trying to restore the identity […]

By Andrew Clark. Information technology is a funny thing. It can make sharing information in a variety of formats faster, more convenient, and more accurate. However, the success of any technological advancement is entirely dependent on the rate at which its use is adopted by the intended users. And adoption depends on a variety of […]

The temperature hit 100 degrees in the nation’s capital and the Patient Protection and Affordable Care Act (PPACA) turned 100 days old during this July 4th holiday week. Even though Congress is on recess this week, there is a still lot of health care in the news. July 1 marks the beginning of fiscal year […]

Dennis G. Smith Earlier this month, an umpire’s mistake cost Detroit Tigers pitcher Armando Galarraga the chance to record a perfect game—27 batters, 27 outs without any opposing player reaching base.  Galarraga would have been only the 21st person in the 135 year history of major league baseball to achieve this distinction.  How rare is […]

Fresh evidence from the Congressional Budget Office (CBO), the Rockefeller Institute, and the National Association of State Budget Officers (NASBO) reveals that the red ink of state and federal budgets continues to spread and structural flaws in government programs will need to be corrected before the national economy returns to good health. CBO Director Douglas […]

  While I have profound disagreement with what President Obama and the Democratic congressional leadership did with passage of the Patient Protection and Affordable Care Act (PPACA), their moment of jubilance is understandable. It was a significant legislative accomplishment. I, too, advocated large-scale reform of our nation’s health care sector. Were the outcome mine to […]

The classic fables of Aesop continue to entertain and enlighten some 2,500 years later. It takes little imagination to relate many of his fables to today’s ongoing debate over the new health care law, the Patient Protection and Affordable Care Act (PPACA). Although he could have never imagined today’s medical technology, his understanding of human […]

With the “Patient Protection and Affordable Care Act” signed into law, President Obama has embarked on a tour to sell the package to a skeptical American public. One of the first stops was Iowa. Recalling the immortal lyrics of Meredith Wilson’s “Iowa Stubborn” from the Music Man, it will probably take more than a whistle […]

The air waves have been abuzz again with stories that doctors will drop out of Medicare because they face a 21 percent reduction in their fees. Congress again is on the brink of whether it would prevent the decrease from going into effect. Congressional leadership has repackaged the “doc fix” as it is known in […]

On February 12, 2010, the White House invited the congressional leadership to a bipartisan meeting on February 25 at the Blair House to discuss health legislation. Since then, there has been much speculation about a new proposal from President Obama that would meet his four- part test to: • Bring down costs for all Americans […]

But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance abuses, let me know. -President Obama, State of the Union, January 27, 2010 Let us adopt President Obama’s words as the aspiration of all Americans and […]

Federal health care legislation came to a screeching halt last week with the Massachusetts Special Election that has sent Scott Brown to the U. S. Senate. Brown opposes the federal legislation in its current form and represents the 41st vote needed to block further consideration of such legislation by the Senate. It is important to […]

I thought you might be interested in a brief report on our progress related to electronic health records (EHR). They are a critical element in making the health care system become value-based. Just having electronic health records isn’t enough. The systems have to be interoperable. Interoperability means that different computer systems and devices can exchange […]

I stopped in Singapore while transitioning between Indonesia and Viet Nam. There were a couple of HHS investments I needed to see. First of all, Singapore took me by surprise. It is beautiful. You would think you were in southern California–climate, quality of infrastructure, construction, etc. It is well run and on a roll of […]

I wrote yesterday in anticipation of going to the Spring Trustee meeting of the Social Security System. I promised a little more commentary today, after the meeting. We met in the Secretary of Treasury’s conference room. The meeting did not include the public trustees, because the appointments expired and none have been confirmed yet. Once […]

I’m sitting at my desk with a bowl of soup for lunch. I have 30 minutes and I’m thinking this might be a good time to respond to a few comments you have sent. First, let me say, I do read the comments. I just have a hard time finding the time to respond and […]

I’m returning from Chicago where we had a meeting of the American Health Information Community. This is the Federal Advisory Committee HHS initiated to advise the Secretary on health information technology standards. I won’t report on the meeting. We Web cast it and it’s available on the HHS Web site if you’re interested (http://www.hhs.gov/healthit/community/meetings/m20071113.html). I […]

This past week, the Congressional Budget Office (CBO) announced that the “Patient Protection and Affordable Care Act” (PPACA) will cost at least $115 billion more than previously estimated and the Obama Department of Justice (DOJ) attorneys filed the government’s response to a lawsuit and defended the new law on the grounds of the power to […]

  How deficit driven reimbursement could dictate future health care investment. I have three kids. All girls ages three, two and one. As their father and “authority” figure, I regularly allow them to do their own thing until something seems to get out of hand, then I intervene and regulate. But frankly, underneath all the […]

By Dennis G. Smith  As Congress prepared to leave town for the Memorial Day recess, there was still a lot going on in health care. Looking back at last week’s events brings to mind a Will Rogers quip, “I don’t make jokes.  I just watch the government and report the facts.”  With that in mind, here is […]

Two leading experts in the development and implementation of health insurance exchanges have joined Leavitt Partners. Cheryl Smith and Dan Schuyler, who directed one of only two health insurance exchanges in the country, will serve as directors in the Leavitt Partners health insurance exchange practice. They join a seasoned team of health policy experts who advise technology vendors, […]

Lots of people handicap elections. Very few take the next step and say what it means for health reform. Borrowing from the time-worn tradition of creating brackets for various sporting events, Leavitt Partners introduces Health Reform Bracketology, a systematic analysis of various election outcomes and what it means to the implementation of the Patient Protection […]