After what looked like a bumpy start, and despite the warnings of some prominent naysayers, the organizations designed to wean providers off of fee for service and to take on financial risk begin to make progress. Uncle Sam is all in, as are many commercial health plans.
Medica health plan in Minneapolis goes all out to communicate with beneficiaries in clear, concise, and jargon-free language. One tip: Don’t overwhelm with words or volume. The insurer has stopped sending out so many letters to consumers, culling 375 down to 175. Brief is almost always better.
Relieving chronic pain while preventing opioid abuse requires vigilance. Enter health plans. Some identify at-risk members as well as prescribers who write an unusually high number of opioid prescriptions. State medical boards should also get more involved, especially when it comes to advertising claims some opioid manufacturers make.
They are: focus on quality and consumer perception, develop an integrated governance structure supported with data, improve data and analytics, and minimize the complexity of the Medicare contract portfolio. Remember, the higher the star rating the more the quality bonus and the more chance of expanding market share.
The ACA is just one reason that providers might want to sponsor their own health plans. Will they be financially viable? Provider-sponsored plans with weak as well as strong cash flows look like they would be. PSHPs have enough capital to expand into commercial markets and/or government programs.
Bret Yarczower, MD
Not only did the number of infants with neonatal abstinence syndrome increase dramatically from 2004 to 2013, but the proportion of NICU days devoted to caring for those infants increased to 4% in 2013 from just 0.6% in 2004, according to a study in the New England Journal of Medicine.