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Kaiser Family Foundation
Well, they’ve defied expectations so far. It was expected that MA enrollment would decline from 10.9 million enrollees (or 24% of all Medicare enrollment) to 8.2 million (15% of Medicare’s total enrollment). Instead, enrollment has continued to climb. In 2016, 17.6 million Medicare beneficiaries—or 31% of all beneficiaries—were in MA plans.
The measures most often used today to assess care quality are process measures. Actual outcomes, of course, are harder to measure than whether a certain action has been taken—checking the feet of a patient with diabetes, for example. But many experts don’t think process measures get at the heart of quality.
FiercePharma has compiled a list of the top 15 cancer medications that are expected to dominate the oncology market in 2022.
The problem, say hospitals and some analysts, is that rating hospital quality is not so straightforward. How a hospital delivers care is multifactorial and complex, they argue, so trying to cram that into a single score is misleading and can end up like rating a restaurant on its parking.
If insurers insist that doctors use older, lower-cost drugs first, the burden is on the health plan to respond to doctors’ request for different medications quickly, nimbly, and appropriately. But quick and nimble do not often describe insurers’ step-therapy efforts.
Joint venture plans are starting to demonstrate their ability to implement clinical management and financial management reforms. A JV health plan replaces the offloading of financial risk by health plans to ill-equipped providers with an executive-level cost management committee stated jointly by the hospital and payer.
For several days, a middle-aged woman who claimed to be a doctor in training roamed the halls of Brigham and Women’s Hospital in Boston, dressed in scrubs, asking questions at a lecture, attending patient rounds, and observing surgical procedures, according to a report in the Boston Globe
Paul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen Expertenstatus nachweißen, liefert er unseren Lesern nicht nur Mehrwert, sondern auch Hilfestellung bei ihren Problemen.