The architect of the ACA waxes defiantly about how effective the law has been and what can be done to make it more so. Also, he is OK with Medicare for all but not the Sanders version.
Competitors are coming together to see if they can leverage blockchain’s magic to solve big problems. Provider directories are among the first use cases.
Crystal Run will close its health plan at the end of this year. Its losses in the small-group market were driven, in part, by risk adjustment. But another major factor was excessive administrative costs, which were three times as high as the administrative costs at established health plans.
Don’t expect politicians to ride to the rescue, says the author of a book that examines just what went wrong and how we can fix it. He puts his faith in entrepreneurs, among others.
Insurers and pharmaceutical companies want ICER to umpire debates about drug prices. But some question the cost-effectiveness calculations of the Boston not-for-profit and its dependence on QALYs.
Perinatal quality collaboratives and other responses may help reverse the trend. But payment reform that gets rid of perverse incentives is a prerequisite.
The evidence base is wobbly, but artificial intelligence is coming on strong and the hype for it is even stronger. Screening for diabetic retinopathy is an early application. Lingering questions include whether the use of AI will contribute to health care inequities rather than solve them.
The storied hospital in Baltimore has hired 70 community health workers and peer recovery specialists from the city’s disadvantaged neighborhoods.
The American College of Emergency Physicians has proposed a payment model that would have ED physicians tracking patients for 30 days after discharge. CMS is mulling it over.
The executive director of the Center for Connected Health Policy talks about the promise and obstacles of embedding this technology into our lives.
Under Anthem’s recently launched Cooperative Care program in South Bend Clinic in Indiana, the ACO’s 150 providers will take on two-sided risk. Cooperative Care also focuses on data sharing and quality measurement as part of a targeted program to bypass prior authorization for select services in which providers have high rates of requests and approvals.
Risk doesn’t faze companies as much as rising premiums, and stop-loss offers some financial protection from the outliers.
Jardiance, Invokana, and other SGLT2 inhibitors may be used to treat and prevent heart failure and kidney disease in people without diabetes.
A newspaper series and a state audit put a spotlight on PBM practices in Ohio. Congress and other states are also looking more closely at what PBMs are delivering to Medicaid health plans.
The University of Pennsylvania has established the first “nudge unit” in a health care system to bring the lessons of behavioral economics to the practice of American health care. The goal is to steer clinicians and patients toward choices that will improve health—and save money.