High Caesarean section rates. Too many babies in the NICU. There are indications that maternity and newborn care in this country is far from ideal. Some payers are betting that bundled payments for obstetricians will create incentives to make changes and reduce low-value care.
This old standby’s ultimate demise will likely take place when cervical cancer incidence declines as the HPV vaccine starts to take effect at a population level. New guidelines are being written, but insurers could have a major influence on how closely those guidelines are followed. So far, though, they haven’t waded very far into the Pap-HPV debate.
Anthem’s vice president of provider alignment solutions wants providers to know that the spigot of upside-only risk arrangements will not stay open forever.
ACOs need to provide comprehensive care management across a spectrum of provider specialties. To do this, they need a framework for evaluating potential partners that will help risk-bearing providers establish the partnerships that will enable them to achieve their goals.
Women make up most of the workforce, but men are in positions of power. Sexual harassment and abuse are common and deep-seated problems in American health care. Women in health care are speaking up and forcing executives and physicians to face the issue.
Providers and payers are being asked to tackle the ‘upstream’ causes of poor health. Medicaid managed care organizations are being asked to screen enrollees for social needs. Some targeted efforts have translated into cost savings and make sense in value-based arrangements. But are we asking the health sector to take on too much?
A look at three different approaches that seek to address social needs in a strategic and somewhat comprehensive way. At this point, all of them are experiments, and no one knows which will prove to be sustainable, replicable, or even beneficial to the patients and communities they seek to serve.
Medicare’s new bundled payments program is expected to be popular, despite unanswered questions about the target prices for the episodes, risk adjustment, and use of quality data. Here’s what we know—and don’t know.
Research has pointed to ways that falls can be prevented, but logistical and financial barriers get in the way.
Building on a similar effort in California, Catalyst for Payment Reform is proposing a standardized set of 50 ACO measures. Some of the country’s largest purchasers are taking it to their health plans.
Once they have the right platforms in place, insurers can layer on predictive analytics, digital medical records, and other innovations that promise to make health care costs more manageable—and in the process make health insurers more competitive with the likes of CVS and maybe, eventually, Amazon.
The 40-year-old has to guide one of the health insurer’s regional markets as the ACA continues to evolve. His course? Keep strengthening ties with providers.
A MedPage Today blog post suggests that they do. Industry veterans say they’re unaware of bonuses for denials but agree prior auth processes should be more transparent.
In theory, this approach could help untangle some knotty cost and quality concerns about medications as they move from clinical trials and into clinical use. But there’s that credibility issue.
Consultants predicted it would be a major business. Large employers and insurers were experimenting with it. But medical tourism has not lived up to the heady expectations. The ACA and moderation of increases in health care costs cooled off interest. Besides, who really wants to go to an unfamiliar place for health care?