They are touted as an alternative to emergency departments. Private companies are seeing an opportunity. But are urgent care centers meeting a demand or creating one?
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.
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.
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.
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.
Perinatal quality collaboratives and other responses may help reverse the trend. But payment reform that gets rid of perverse incentives is a prerequisite.
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.
CAR-T treatments are all the rage and showing some remarkable results. But the high price, along with the lack of long-term results, quiets the optimism.
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.
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.
Too often, the prices of health care services and drugs are cloaked in mystery. A growing consensus demands that patients be given a clearer sense, in advance, of what things will cost. But there are obstacles–and some people benefit from the present confusion.
The contract between UPMC Health Plan and AstraZeneca will help the brand-name antiplatelet drug compete against generic versions of Plavix by lowering the copay to $10.
When patients and their medical records are out of whack, it causes harm and wastes money. American attitudes about privacy—and the multitude of competing provider organizations—makes the patient matching problem hard to fix.
Risk doesn’t faze companies as much as rising premiums, and stop-loss offers some financial protection from the outliers.