Our Latest Thinking

We are constantly scanning the health care market for new and interesting developments; then we write about them here. Check out our latest thinking.

Centers for Medicare and Medicaid Services (CMS)

Why Patients Readmit: Using a Readmission Curve to Identify Patients at Risk for Hospital Readmission Following Hip and Knee Replacement Surgery

August 24th, 2017

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.

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The Opioid Epidemic and State Responses

August 17th, 2017

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 […]

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Adding Complexity to an Already Complex Process

August 15th, 2017

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, […]

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

July 17th, 2017

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 […]

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Dual Eligibles: Lessons Learned & Future Implications

June 28th, 2017

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.

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CJR: Playing the Waiting Game

June 6th, 2017

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 […]

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So You’re Thinking about Bundling: Where to Start & With Whom

May 15th, 2017

Bundled payments are a great option for organizations that are interested in taking on risk, but don’t have the appetite to form an ACO. Bundle payments group costs associated with a particular treatment or episode of care, offering health systems a longitudinal look at the care cycle that can help them efficiently allocate resources. The CMS Bundled […]

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The “Exit Polls”: Initial Thoughts on PTAC’s First Meeting

May 11th, 2017

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 […]

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