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Why bundled payments are poised to take off. 为什么捆绑支付即将起飞。
Managed Care Pub Date : 2018-12-01
Michael D Dalzell
{"title":"Why bundled payments are poised to take off.","authors":"Michael D Dalzell","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>CMS's Bundled Payments for Care Improvement (BPCI) Advanced program signals a willingness among Medicare providers to redesign care and take on risk. More than 1,500 hospitals and physician groups signed up-north of what was expected for a program that includes downside risk from Day 1. Commercial payers are watching closely.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"27 12","pages":"18-19"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36844112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Improving Behavioral Health Access In a Time of Severe Provider Shortage. 在提供者严重短缺的情况下改善行为健康获取。
Managed Care Pub Date : 2018-12-01
Petra Esseling
{"title":"Improving Behavioral Health Access In a Time of Severe Provider Shortage.","authors":"Petra Esseling","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Despite high need and urgency, patient adherence is low. One might think that puts the onus on patients, but a major reason for this gloomy picture is the severe shortage of mental health professionals across the country-a shortage that's only going to increase.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"27 12","pages":"37"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36844122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Why employers are offering more choices in health plans next year. 为什么雇主明年会在健康计划中提供更多的选择?
Managed Care Pub Date : 2018-12-01
Jan Greene
{"title":"Why employers are offering more choices in health plans next year.","authors":"Jan Greene","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>It's a tight labor market and employer surveys show a modest but steady uptick in employer health benefit spending for the coming year-about 5% on average. Much of that increase will go toward specialty drugs, the benefit with the biggest price hikes.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"27 12","pages":"21-22"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36844113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Financial Analysis of New York City Start-up Health Plans and Reasons for Their Losses. 纽约市创业健康计划的财务分析及其亏损原因
Managed Care Pub Date : 2018-12-01
Adam E Block
{"title":"A Financial Analysis of New York City Start-up Health Plans and Reasons for Their Losses.","authors":"Adam E Block","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>Using New York City as an example, this research explores reasons for the consistently poor financial performance of three start-up health plans (Health Republic, CareConnect, and Oscar) while other health plans have performed relatively well in the same market.</p><p><strong>Design and methods: </strong>This study compiles insurer data from financial years 2014 through 2016, submitted to the New York State Department of Financial Services as part of the rate-review process, including premium revenue, claims cost, risk adjustment, administrative costs, net income, and premium. The financial data were used to create a novel metric, adjusted net income, that evaluates the financial performance of an insurer excluding risk adjustment and assuming a market average administrative cost. Descriptive statistics were used to compare the performance of start-up plans, commercial plans, and Medicaid plans in the ACA exchange market.</p><p><strong>Results: </strong>Premiums for start-up plans were within 9% of median silver premiums yet adjusted net income was negative (-$190 PMPM) for all three start-ups while it is positive (+$27 PMPM) for the non-start-ups. The difference in adjusted net incomes shows that poor financial performance of start-ups was due to claims costs, not high administrative costs and poor performance in risk adjustment.</p><p><strong>Conclusion: </strong>The consistent financial losses by New York City start-ups is driven by higher-cost provider contracts for the start-ups relative to competitors.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"27 12","pages":"34-36"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36844123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Why the politics will continue to favor protections for Americans with pre-existing conditions. 为什么政治会继续支持保护已有疾病的美国人。
Managed Care Pub Date : 2018-12-01
Richard Mark Kirkner
{"title":"Why the politics will continue to favor protections for Americans with pre-existing conditions.","authors":"Richard Mark Kirkner","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Is it any wonder that Republican office holders are changing their tune regarding pre-existing conditions? Kaiser Family Foundation polling reports that overwhelming majorities say it is \"very important\" that the ACA's protections for people with pre-existing conditions (75%) remain. Even 58% of Republicans agree.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"27 12","pages":"19-20"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36844114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Why vertical will continue to be the favored direction for PBMs, insurers. 为什么垂直将继续是pbm和保险公司青睐的方向。
Managed Care Pub Date : 2018-12-01
Robert Calandra
{"title":"Why vertical will continue to be the favored direction for PBMs, insurers.","authors":"Robert Calandra","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Getting vertical theoretically will allow the new entities to capitalize on efficiencies in care management, total cost of claims, and other programs while creating an all-in-one health care product that provides more services at less cost. At least that's the spin.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"27 12","pages":"32"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36844118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Payer Collaboration Leaders Could Ease Payer, Provider Tensions. 支付方合作领导人可以缓解支付方和供应商之间的紧张关系。
Managed Care Pub Date : 2018-12-01
Jesse Ford
{"title":"Payer Collaboration Leaders Could Ease Payer, Provider Tensions.","authors":"Jesse Ford","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Having a payer collaboration leader is especially important for large health systems that have yet to fully consolidate revenue cycle operations following a merger or have far-flung operations in multiple states. They may vary in some details, but the same payer issues tend to crop up across a health system.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"27 12","pages":"41"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36833469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Why blockchain for health care may be finally turning the corner. 为什么医疗保健领域的区块链可能最终会出现转机。
Managed Care Pub Date : 2018-12-01
Richard Mark Kirkner
{"title":"Why blockchain for health care may be finally turning the corner.","authors":"Richard Mark Kirkner","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This fall, PricewaterhouseCoopers issued a report on blockchain in health care and outlined six areas where it could have a profound impact: supply chain and inventory management; enrollment and provider data management; back office functions and payments; data management; managing risk and regulatory issues; and research and development.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"27 12","pages":"22-23"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36844115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Accelerating the Move Toward Value: Strategies for 2019 and Beyond. 加速走向价值:2019年及以后的战略。
Managed Care Pub Date : 2018-12-01
Emad Rizk
{"title":"Accelerating the Move Toward Value: Strategies for 2019 and Beyond.","authors":"Emad Rizk","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The past decade has seen advances in payer-provider collaboration and data sharing that reflect clinical, economic, and administrative alignment. What's needed now is a deeper level of commitment to drive sustainable improvements in quality and cost.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"27 12","pages":"40"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36833468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Wide Angle Lens on Adverse Events. 不良事件的广角镜头。
Managed Care Pub Date : 2018-12-01
Peter Wehrwein
{"title":"A Wide Angle Lens on Adverse Events.","authors":"Peter Wehrwein","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Blue Health Intelligence conducted an analysis of a commercial health plan claims database and adverse events that is designed to paint a fuller, real-world picture of adverse events. The database included patients, ages 18-64, admitted to the hospital in 2016 and 2017.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"27 12","pages":"34-36"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36844119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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