Leavitt Partners Blog

Colossal Rate Increases; The Exception Or The New Rule
August 10, 2016

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 […]

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CMS Proposes New Mandatory Bundled Payment Models: 4 Observations
July 29, 2016

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 model (SHFFT), and outlines a […]

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Incentivizing Young Adults to Buy Health Insurance
July 8, 2016

In a recent announcement, CMS acknowledged the need to insure younger and healthier adults in order to contribute to a more balanced Marketplace risk pool and lower costs. CMS detailed a series of actions to step-up Marketplace outreach, especially to young adults who are still more likely than average to remain uninsured. While the suggested actions, […]

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CMS Announces OCM Participants: Three Notable Facts
July 8, 2016

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 […]

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Bundled Payments Gaining Adoption; Provider Participants Seeking Care Redesign
June 28, 2016

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 […]

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Oncology Care Model (OCM) Bundle: 8 Summary Thoughts
June 24, 2016

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 […]

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LP Data Insight: Medicare Spend by Service Type and Beneficiary Age
June 14, 2016

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 consist of 100% of all FFS claims for inpatient, outpatient, home health, skilled nursing facilities (SNF), and hospice. However, they include only a 5% sample for claims related to durable medical equipment […]

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Comprehensive Primary Care Plus (CPC+): 4 Positive Implications & 2 Practice Strategies
June 9, 2016

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, […]

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