We usually want to be in the middle of networks with plenty of strength and sprawl. People strive to have large professional and social networks. Wirelesss carriers brag about how big and reliable their networks are.
It was that way in health care, too. After the pushback against managed care in the 1990s, insurers loosened the reins. Come open enrollment, people were enticed to sign up for a health plan that had cast a wide net with a wide choice of providers or, often more importantly, a plan that their favorite doctor accepted.
But now all talk is of narrow networks and being much more selective—some providers say discriminatory—about which providers are included in health plan’s network, all in the name of value-based care.
If you're into health care policy and law, tomorrow is your Superbowl, World Series, and World Cup all rolled into one.
Oral arguments for King v. Burwellare scheduled to start tomorrow at 10 a.m. As Richard Mark Kirkner explained in our February issue, the case could uphold the ACA or severely crimp the law by eliminating premium subsidies in the 34 states that use the federal health exchange.
The ACA has been resilient, and many health care interests would rather live with the law, despite its flaws, than see it come undone.
Last May, two health advocacy groups filed a complaint with the Office for Civil Rights at HHS accusing four insurers selling plans in Florida of discriminating against people with HIV/AIDS by putting the drugs for treating the condition on the top tier of their formularies.
Researchers at the Harvard School of Public Health have followed up that complaint with their own research into what they are calling “adverse tiering.” The researchers, Douglas B. Jacobs and Benjamin D. Sommers, reported their results in this week’s New England Journal of Medicine.
The Harvard researchers looked at silver-level plans listed in the federal health exchange in 12 states, six with insurers mentioned in the complaint (Delaware, Florida, Louisiana, Michigan, South Carolina, and Utah) and six of the most populous states without any of those insurers (Illinois, New Jersey, Ohio, Pennsylvania, Texas, and Virginia).
The use of new hepatitis C therapies will increase rapidly, but the effect on spending is greatest early on, according to a PricewaterhouseCoopers analysis. According to the consulting firm’s projections, the expensive medications will eventually lower health care spending because they will improve the health of people with hepatitis C patients, so liver transplants and other high-cost medical interventions will be avoided.
Source: “Medical Cost Trend: Behind the Numbers 2015,” PricewaterhouseCoopers Health Research Institute, June 2014. PwC analysis based on National Health and Nutrition Examination Survey and 2012 Truven claims data from employers.
Three more organizations have exited CMS’s Pioneer accountable care organization (ACO) program, leaving just 19 of the original 32 participants in the fold for the elite program’s third year.
The Franciscan Alliance in Indianapolis, the Genesys Physician Hospital Organization in Flint, Mich., and the Renaissance Health Network in Wayne, Pa., in the southeastern part of the state, are leaving the Pioneer program, according to a list posted on the CMS website this afternoon.
Sharp Healthcare in San Diego had announced in August that it was dropping out.
Maybe, just maybe, accountable care organizations (ACOs) are the best bet for hitting the health care exacta of controlling costs and improving the quality of care.
Figures released by CMS on September 16 showed that the 23 organizations in the elite Pioneer program and 220 in the Shared Savings program produced over $372 million in savings while earning $445 million in shared savings payments.
So last week it was all doom and gloom about Pioneer ACOs.
The buzz in health care wonkdom was all about 9 of the 32 organizations defecting from a program supposedly designed for the best and brightest of American health care organizations — with maybe more to follow. Accepting downside risk was just too perilous. Lags in getting data from Centers for Medicare & Medicaid Services (CMS) were undermining cost and quality control efforts. And the contradiction of being responsible (aka accountable) for the costs of Medicare enrollees but having no direct control over where they receive care — a central feature of the ACO model — was simply untenable.
But this morning CMS attempted to change the doleful Pioneer ACO tune with a long-awaited announcement of cost and quality results from 2012, the first year the Pioneer ACOs were in operation.