Health Policy

The Strange Financial Interactions Between Medicare ACOs and Bundled Payment Participants

Episode Choices and Bundled Payment Risk

Earlier in 2013 we wrote an article about the effect of selection of individual DRGs for participation in the Medicare Bundled Payment for Care Improvement (BPCI) program.

Do Readmissions Cost More than Non-Readmissions?

One of the challenges in working in healthcare data analytics is the requirement to keep up-to-date on many diverse topics. The eHealth Initiative provides a multitude of such opportunities, and we enjoyed attending the recent National Forum on Data and Analytics at which we heard a wide variety of presentations on many topics related to the management and analysis of healthcare data.

WSJ Article on Provider Payment and Quality Metrics

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Here’s an interesting Wall Street Journal debate on the “Physician Pay for Performance” issue.  One writer favors pay-for-performance incentives, arguing that fee-for-service payment creates improper incentives for providers to over-treat patients. This writer focused on the financial incentives, and measured success based on changes in utilization patterns or costs.

Emerging Payment Models for ACOs and Bundled Payments

At the recent Becker’s Hospital Review Annual Meeting in Chicago, several presentations covered accountable care organizations, bundled payments and other new payment methodologies. Although not described specifically in these presentations, two different payment arrangements are emerging in which payers and providers are cooperating to reduce healthcare costs. This article compares and contrasts those payment methodologies.

"Cracking Health Costs" Reviewed

Over the recent weeks, numerous challenges have appeared to the “conventional wisdom” of healthcare reform.  Often touted as the solution to the growth in healthcare spending, accountable care organizations are now experiencing potential defections from the Pioneer ACO program, and

How Successful Care Management Programs Actually Work

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In the midst of numerous stories touting the promise of CMS initiatives for care improvement such as ACOs, one success story almost always gets overlooked.  Dr. Ken Coburn’s Health Quality Partners shop in Bucks County PA is one of the only care management programs that has actually demonstrated success. There are no magic bullets in the HQP program – they rely on solid personally-delivered healthcare.

Will the ACA's Market Forces Reduce Costs?

Here’s an interesting article by healthcare economist Bob Laszewski on the nuances in the new California insurance rates.

What Does the Oregon Medicaid Report Tell Us About Health Insurance?

Few recent issues have generated as much contradictory interpretation from the same set of facts at the recent release in the New England Journal of Medicine (link is here, but requires subscription) of its analysis of the Oregon Medicaid program.

Can Accountable Care Succeed without Accountable Patients?

The movement towards accountable care is focused on making all providers "accountable" for the health status of their patients throughout the healthcare delivery system. Many of the guidelines for patient treatment revolve around physicians and other providers following "best practices", which have been established to provide the best combination of care and cost effectiveness for the overall population.

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