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One potential ACA replacement strategy could include punting health care reform to the states. The incoming administration could accomplish this is by significantly relaxing the 1332 innovation waiver requirements.
From a security perspective the last 24 months have proven to be quite detrimental to the health care industry with dozens of successful and very public and costly cyber / malware attacks. These attacks are relentless and increasing. As the health care industry explores solutions to mitigate and defend against attacks, one technology that is […]
Not Losing Sight of the Dual Eligible in the Move to Value Based Payments Value-based payments arrangements are increasing. While most of this movement is being driven through Medicare-based payment initiatives, CMS is now increasingly pushing value-based payments in Medicaid based on the success CMS has achieved in Medicare. The shift to value-based payments is […]
Medicare Advantage (MA) offers Medicare benefits through private health plans, providing an alternative to the traditional, federally-administered program. Also known as Medicare Part C, this private option traces its roots to the 1970s and received its current name and form in the Medicare Modernization Act of 2003. Since then, the number of enrollees has grown […]
Insurance premiums under the Affordable Care Act (ACA) are receiving increased attention due to reports of sharp 2017 increases by insurers. Across the nation, insurers have submitted initial premium increases and it is not uncommon for insurers to submit proposed rate increases in excess of 40-50% for 2017. State regulators will review the requests meticulously […]
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 […]
By Dan Schuyler & Sean Mullin. 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 […]
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 […]