Since the formation of the Medicare Advantage (MA) program, there has been continuous growth in the number of Medicare beneficiaries that have chosen this model of care. The reasons are numerous. For instance, the pace of growth in the number of company offerings and members has picked up over recent years, and the current projection is that MA… Read More »
There has been a great deal of focus on whether nonprofit hospitals bring value to the communities they serve in proportion to their tax-exempt status. The argument is that the tax dollars are necessary and properly utilized for community benefit; therefore, a tax-exempt status requires community benefit in replacement of payments. The measure used as a metric for… Read More »
We are a country founded on individual rights. As a society, we have also decided that healthcare is a right of citizenship; we do not permit the denial of care based on one’s ability to pay. Unfortunately, the cost of the administrative components of the healthcare ecosystem is a burden on the overall cost of care. Many of… Read More »
Capitation, as a value-based payment model, has been around for decades. Many of us have experimented with variations of capitation, ranging from full capitation for all healthcare services to specialist capitation, to primary care (PCP) capitation. Currently, Primary Care Clinicians are much more comfortable with the nuances of these models because of the expansion of Medicare Advantage. This… Read More »
Bundled payments for episodes of services such as joint replacements are not a new concept. Throughout the years, the Centers for Medicare & Medicaid Services (CMS) have experimented with Bundled Payment Programs with limited success. After factoring in bonus payments to providers, the net savings to Medicare has been minimal, and on the positive side, there is no… Read More »
As we continue to focus on value-based payment models, there is a strong belief that moving away from fee-for-service payments towards a per-patient rate for primary care providers will decrease overall costs. The counter concern is that this may also lead to reduced care because of the financial incentive to avoid services. Primary care providers (PCPs) have the… Read More »
There is a definite belief that if we invest in care that prevents Emergency Room visits and hospitalizations, there is a positive impact on outcomes and costs. For instance, a recent study in Health Affairs by Wright et al. evaluated this belief in the Iowa Medicaid Healthy Behaviors Program. In their research, they found a substantial decrease in… Read More »