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| "Health plans are frustrated because they pay for a lot of care that evidence shows doesn’t improve outcomes or help patients on their journey to health and wellness. Payers are happy to pay for health care if it’s necessary. But it doesn’t make sense to pay for care that doesn’t add value. Reinvention means reducing this financial waste to bring down the cost of coverage for everyone. | ||
| -Wyatt Decker, MD, MBA, Chief Executive Officer, OptumHealth |
| The median
monthly ACA premium in 2017 was $451 in areas with one insurer
compared with just over $300 in markets with three to five
insurers; and $270 in those with six or more insurers. The
number of insurance companies offering plans in ACA marketplaces
has fluctuated. From 2014 to 2016, the average number was
between five and six; declining to 3.5 in 2018. This year, the average number of plans ticked up to
four. But variability among states is still substantial. Four
states — Alaska, Delaware, Mississippi and Wyoming — have just
one ACA insurer this year. In contrast, seven states —
California, Massachusetts, Michigan, New York, Ohio, Texas and
Wisconsin – have eight insurers or more. Source: Kaiser Health News: As States Strive To Stabilize Insurance Marketplaces, Insurers Return |
|
Tufts Health Plan and Harvard Pilgrim Health Care combine organizations Harvard Pilgrim, August 14, 2019 Hospitals call for overhauling Medicare Advantage prior authorization rules Modern Healthcare, August 13, 2019 Doctors unaware of where their patients live impacts care Houston Chronicle, August 13, 2019 To Save Money, American Patients And Surgeons Meet In Cancun Kaiser Health News, August 12, 2019 Trump Shift, Backed by States, Fuels Fear of Too Few Medicaid Docs Stateline, August 7, 2019 Amazon’s PillPack battling with CVS and Walgreens over patient prescriptions CNBC, August 6, 2019 HHS and FDA release drug importation plan to lower prices Fierce Healthcare, July 31, 2019 Medicare pilot gives physicians access to patients' claims data Modern Healthcare, July 30, 2019BC, July 9, 2019 CMS Unveils Sweeping Proposed Mandates on Hospital Pricing Transparency HealthLeaders, July 29, 2019 Despite calls to start over, US health system covers 90% Associated Press, July 28, 2019 |
|
As States Strive To Stabilize Insurance Marketplaces, Insurers
Return Kaiser Health News, August 14, 2019 Doctors Argue Plans To Remedy Surprise Medical Bills Will ‘Shred’ The Safety Net Kaiser Health News, August 7, 2019 Potential Impact of a Medicare Public Option On Rural Hospitals, Communities Navigant, August 2019 Is Timing Right For An Anthem-HCSC Blue Cross Mega Merger? Forbes, August 6, 2019 Opinion: Health insurance group CEO: Medical costs 'at a tipping point' USA Today, August 2, 2019 Reinventing health care - The U.S. has fantastic health care, the problem is... Optum, August 1, 2019 |
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Policy Briefs: Scott Atlas On Why Competition, Not Laws, Will
Make Health Care Prices Visible
More patient control over health care spending
will lead to more price visibility and lower costs. But contrary
to popular belief, legislation isn’t necessary to make prices
more visible in the health care system. The most compelling
reason for doctors and hospitals to post their prices would be
because they are competing for patients’ money. |
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Check out
HealthshareTV, the
home for health care videos |
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|
CMS' final inpatient payment
rule for 2020: 8 things to know 1. Acute care hospitals that report quality data and are meaningful users of EHRs will receive a 3.1 percent increase in Medicare rates in fiscal year 2020, compared to fiscal 2019. 2. CMS projects the rate increase, together with other changes to inpatient payment policies, will boost total IPPS payments by roughly $3.8 billion. 3. CMS will distribute nearly $8.4 billion in DSH payments in fiscal 2020, an increase of approximately $78 million from fiscal 2019. 4. CMS will increase the maximum add-on payment for new technology, including CAR-T cancer therapy, from 50 percent of estimated costs to 65 percent. 5. In a statement, American Hospital Association Executive Vice President Tom Nickels said the AHA is pleased CMS increased the add-on payment rate. 6. CMS will increase the wage index for hospitals with a wage index value below the 25th percentile. The agency will adjust the standardized amounts for all hospitals to make this policy budget neutral. 7. CMS finalized changes to the "rural floor" calculation, which requires the wage index values for urban hospitals to be no lower than the wage index values for rural hospitals in the same state. 8. "It appears that hospitals in a limited number of states have used urban to rural hospital reclassifications to inappropriately influence the rural floor wage index value," CMS said in a fact sheet. Source: Becker's Hospital Review |
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