CMS Outlines Methodology to Determine Payments Under Basic Health Program
October 22, 2014
The CMS has released methodology and data sources for determining federal payments in 2016 to states establishing an alternative coverage program for low-income people under the Affordable Care Act. The proposed notice on the Basic Health Program, released Oct. 21, will be published in the Oct. 23 Federal Register. Comments are due Nov. 24. The CMS plans to issue a final notice by February. The BHP option allows states to establish a health benefits program for lower-income people as an alternative to coverage available on state-based or federal health insurance marketplaces. The provision was authored by Sen. Maria Cantwell (D-Wash.). The voluntary program enables states to create a program for individuals with income too high to qualify for Medicaid or the Children's Health Insurance Program but who are in the lowest income bracket of people eligible to purchase coverage on the marketplaces.
Pioneer Accountable Care Organizations (ACOs): Slowed Health Spending, Improved Quality and More Drop Outs?
National Law Review
October 21, 2014
The Centers for Medicare and Medicaid Services (CMS) recently released second year results on its Pioneer Accountable Care Organization (ACO) program.  The Pioneer ACO program is CMS’ ambitious foray into the ACO space and a predecessor to the broader Medicare Shared Savings Program (MSSP) that has resulted in the formation of hundreds of new ACOs nationwide. CMS originally selected 32 provider organizations with a proven ability to coordinate care for their patients with the goal of transitioning the providers in those organizations from a fee-for-service payment model, to a shared savings model and finally to a population based payment model. The Pioneer ACO program kicked off in 2012 and was intended to (1) improve quality and health outcomes for patients served by each Pioneer ACO, (2) achieve cost savings for the Medicare program and (3) reward providers who were able to achieve the dual goals of cost savings and improved quality.
Few motives to fix busted health data
October 21, 2014
Some patients in these systems already are benefiting from “wrap-around” care that relies on good data, shared among medical professionals. Such success stories have popped up around the country in tandem with growing consolidation of health networks and the Affordable Care Act-fostered creation of accountable care organizations — in which doctors are nudged toward focusing on patients, rather than procedures. In such organizations, information sharing among doctors and hospitals is vital. Shifts in the Medicare payment schemes for doctors next year could also force the medical profession into more reliance on sharing. “Value-based care may not succeed with good information, but it can’t succeed without it,” says Josh Seidman, a former HHS health IT official who is now a vice president at Avalere Health. To date, though, most hospitals and provider networks aren’t financially motivated to freely share their patients and data with others. It will cost money to get their computer to share data. Providers, having already spent plenty, aren’t enthusiastic about spending more to meet the demands of the federal incentive program.
Only 11 Percent of Uninsured Know About Obamacare’s Next Open Enrollment
The New York Times
October 21, 2014
This year, the big challenge for officials behind the Affordable Care Act may not be making the website work but getting customers to come shop in the first place. A new survey of people without health insurance highlights the challenge: It found that 89 percent of the people surveyed were unaware that open enrollment begins in November, or any time soon. That’s a big deal because, unlike last year, the enrollment period for marketplace plans is only three months long. Most people who want to buy policies on new state marketplaces need to pick their plan between Nov. 15 and Feb. 15, or they’ll have to wait another year. Under the Affordable Care Act, most Americans are required to obtain health insurance or pay a fine, and projections from the Congressional Budget Office estimate that millions more will enroll this year. People with incomes low enough to qualify for Medicaid — about $27,000 for a family of three — can sign up for insurance at any time. But the open enrollment period applies to everyone else who doesn’t experience a major life change during the year, such as losing a job or getting divorced. Of course, in order to sign up for coverage, eligible people need to know it’s available.
This Week: Another Committee Hearing on Ebola; Groups Examine Improvements to the Delivery of Health Care
October 20, 2014
A forum today examines current training and certification standards, best practices and challenges for community health workers. A video of the session will be posted after the discussion. Also, the Brookings Institution will broadcast a half-day forum examining the latest results of accountable care organizations (ACO) efforts to overhaul the delivery of health care. The ACO’s are empowered by the Affordable Care Act to change the method of care delivery with an eye toward reducing health care costs. Also this week, a Capitol Hill conference features prominent health group leaders addressing how hospitals and health systems can foster improvements in delivering health care services. Meanwhile, IBM hosts a conference this week in Arlington, Virginia exhibiting new approaches to delivering health and social programs and the U.S. Chamber of Commerce weighs in with a conference on Wednesday on how the private sector can drive improvements to the health care delivery system
Medicare patients pay more at rural hospitals
October 20, 2014
An electrocardiogram, used to monitor heartbeats, will cost a Medicare patient about $5 at the average hospital but nearly $33 at a rural, critical access hospital. ECGs and nine other frequently provided outpatient services cost from two to six times more for Medicare patients at the nation's rural, critical access hospitals compared to other hospitals, according to a report by the U.S. Department of Health and Human Services' Inspector General. Critical access hospitals are typically more remote, have fewer beds and require shorter stays. Ohio has 34 of them, or 1 in 5 hospitals in the state, including Pike Community Hospital. Eric Draime, chief financial officer for Avita Health Systems, which includes the Galion and Bucyrus hospitals, said it's not the rural hospitals' fault.
Could open enrollment determine the Senate?
October 20, 2014
As if there weren’t enough pressure on Andy Slavitt, Kevin Counihan and the team at HealthCare.gov, here comes Louisiana and Georgia. With the Senate races there looking more and more likely to head into a runoff, and open enrollment scheduled for Nov. 15, residents of the two states could be checking into HealthCare.gov at the exact moment they’re considering their vote. Your PULSERs past and present consider the effects of tech glitches and premium hikes on those elections when, as Kaiser Family Foundation’s Larry Levitt put it, there’ll be “quite a bit more spin than data.”
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