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Uncategorized

The National DPP Coverage Toolkit: Timely Tools for Payers Addressing Prediabetes

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 … Read more

The Opioid Epidemic and State Responses

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 are harming individuals, families, the … Read more

Using Alternative Payment Models to Address Health Care Disparities

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 in the … Read more

The Medicare-Medicaid ACO Model: Addressing Dual Eligibles’ Costs

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 population. However, … Read more

Dual Eligibles: Lessons Learned & Future Implications

Introduction 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. One of the biggest challenges in moving dual eligibles to value-based payments is solving the logistical and … Read more

Micro-Hospitals: A Unique Opportunity to Deliver Care to Underserved Areas Amidst the Transition to Value

Micro-Hospitals Defined While the health care industry continues to shift from volume to value, costs of inpatient care continue to rise, averaging $2,346 per inpatient per day. Consequently, payers and providers are seeking new ways to reduce hospital length of stay (LOS) and deliver care at less costly locations. One such mechanism is the emerging trend … Read more

The Future of Medicare Telehealth Coverage: CBO Hesitates, Congress Inches Forward

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, … Read more

CJR: Playing the Waiting Game

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 year into … Read more

The MACRA All-Payer Advanced APM Pathway: System-Wide Implications

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, … Read more

The Future of Medicaid

The Affordable Care Act turned Medicaid into America’s largest public health care coverage program. While the volume associated with this growing program created increasing opportunities for providers, health systems, health plans, and vendors, these same stakeholders shouldn’t write off opportunities in Medicaid now simply because of the change in direction at the federal level. Instead, … Read more