Issue brief (George Washington University. National Health Policy Forum : 2005)最新文献

The Star Rating System and Medicare Advantage Plans. 星级评级系统和医疗保险优势计划。

Issue brief (George Washington University. National Health Policy Forum : 2005) Pub Date : 2015-05-05

Lisa Sprague

{"title":"The Star Rating System and Medicare Advantage Plans.","authors":"Lisa Sprague","doi":"","DOIUrl":"","url":null,"abstract":"With nearly 30 percent of Medicare beneficiaries opting to enroll in Medicare Advantage (MA) plans instead of fee-for-service Medicare, it's safe to say the MA program is quite popular. The Centers for Medicare & Medicaid Services (CMS) administers a Star Ratings program for MA plans, which offers measures of quality and service among the plans that are used not only to help beneficiaries choose plans but also to award additional payments to plans that meet high standards. These additional payments, in turn, are used by plans to provide additional benefits to beneficiaries or to reduce cost sharing--added features that are likely to factor into beneficiaries' choice of MA plans. The Star Ratings program is also meant to drive improvements in the quality of plans, and this secondary effort seems to have been successful. Despite this success, issues with the Star Ratings system remain, including: how performance metrics are developed, chosen, and maintained; how differences among beneficiary populations (particularly with regard to the dually eligible and those receiving low-income subsidies) should be recognized; and the extent to which health plans can control the variables on which they are being measured. Because the Star Ratings approach has been extended to providers of health care as well--hospitals, nursing homes, and dialysis facilities--these issues are worth exploring as CMS fine-tunes its methods of measurement.","PeriodicalId":87188,"journal":{"name":"Issue brief (George Washington University. National Health Policy Forum : 2005)","volume":" 854","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2015-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33385019","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

Telehealth: into the mainstream? 远程医疗:成为主流?

Issue brief (George Washington University. National Health Policy Forum : 2005) Pub Date : 2014-03-10

Lisa Sprague

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Seeking value in Medicare: performance measurement for clinical professionals. 在医疗保险中寻求价值:临床专业人员的绩效评估。

Issue brief (George Washington University. National Health Policy Forum : 2005) Pub Date : 2013-10-30

Lisa Sprague

引用次数: 0

Health workforce needs: projections complicated by practice and technology changes. 卫生人力需求:因实践和技术变化而复杂化的预测。

Issue brief (George Washington University. National Health Policy Forum : 2005) Pub Date : 2013-10-22

Rob Cunningham

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Medicare Advantage update: benefits, enrollment, and payments after the ACA. 医疗保险优势更新:ACA之后的福利、登记和付款。

Issue brief (George Washington University. National Health Policy Forum : 2005) Pub Date : 2013-07-19

Kathryn Linehan

{"title":"Medicare Advantage update: benefits, enrollment, and payments after the ACA.","authors":"Kathryn Linehan","doi":"","DOIUrl":"","url":null,"abstract":"In 2012, the Medicare program paid private health plans $136 billion to cover about 13 million beneficiaries who received Part A and B benefits through the Medicare Advantage (MA) program rather than traditional fee-for-service (FFS) Medicare. Private plans have been a part of the program since the 1970s. Debate about the policy goals--Should they cost less per beneficiary than FFS Medicare? Should they be available to all beneficiaries? Should they be able to offer additional benefits?--has long accompanied Medicare's private plan option.This debate is reflected in the history of Medicare payment policy,and policy decisions over the years have affected plans' willingness to participate and beneficiaries' enrollment at different periods of the program. Recently, evidence that the Medicare program was paying more per beneficiary in MA relative to what would have been spent under FFS Medicare prompted policymakers to reduce MA payments in the Patient Protection and Affordable Care Act of 2010 (ACA). So far, plans continue to participate in MA and enrollment continues to grow, but payment reductions in 2012 through 2014 have been partially offset by payments made to plans through the quality bonus payment demonstration.This brief contains recent data on plan enrollment, availability, and benefits and discusses MA plan payment policy, including changes to MA payment made in the ACA and their actual and projected effects.","PeriodicalId":87188,"journal":{"name":"Issue brief (George Washington University. National Health Policy Forum : 2005)","volume":" 850","pages":"1-12"},"PeriodicalIF":0.0,"publicationDate":"2013-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31745656","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}

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CMS's proposed rule implementing the ACA-mandated Medicaid DSH reductions. CMS的拟议规则实施aca强制医疗补助DSH削减。

Issue brief (George Washington University. National Health Policy Forum : 2005) Pub Date : 2013-06-25

Kathryn Linehan

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Changes in latitudes, changes in attitudes: FQHCs and community clinics in a reformed health care market. 纬度的变化，态度的变化:改革后的医疗保健市场中的fqhc和社区诊所。

Issue brief (George Washington University. National Health Policy Forum : 2005) Pub Date : 2012-12-18

Jessamy Taylor

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Medicare's post-acute care payment: a review of the issues and policy proposals. 医疗保险的急症后护理支付:对问题和政策建议的回顾。

Issue brief (George Washington University. National Health Policy Forum : 2005) Pub Date : 2012-12-07

Kathryn Linehan

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Community health workers: a front line for primary care? 社区卫生工作者:初级保健的前线?

Issue brief (George Washington University. National Health Policy Forum : 2005) Pub Date : 2012-09-17

Lisa Sprague

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Recent proposals to limit Medigap coverage and modify Medicare cost sharing. 最近关于限制医疗保险覆盖范围和修改医疗保险费用分摊的提案。

Issue brief (George Washington University. National Health Policy Forum : 2005) Pub Date : 2012-02-24

Kathryn Linehan

{"title":"Recent proposals to limit Medigap coverage and modify Medicare cost sharing.","authors":"Kathryn Linehan","doi":"","DOIUrl":"","url":null,"abstract":"As policymakers look for savings from the Medicare program, some have proposed eliminating or discouraging \"first-dollar coverage\" available through privately purchased Medigap policies. Medigap coverage, which beneficiaries obtain to protect themselves from Medicare's cost-sharing requirements and its lack of a cap on out-of-pocket spending, may discourage the judicious use of medical services by reducing or eliminating beneficiary cost sharing. It is estimated that eliminating such coverage, which has been shown to be associated with higher Medicare spending, and requiring some cost sharing would encourage beneficiaries to reduce their service use and thus reduce program spending. However, eliminating first-dollar coverage could cause some beneficiaries to incur higher spending or forego necessary services. Some policy proposals to eliminate first-dollar coverage would also modify Medicare's cost sharing and add an out-of-pocket spending cap for fee-for-service Medicare. This paper discusses Medicare's current cost-sharing requirements, Medigap insurance, and proposals to modify Medicare's cost sharing and eliminate first-dollar coverage in Medigap plans. It reviews the evidence on the effects of first-dollar coverage on spending, some objections to eliminating first-dollar coverage, and results of research that has modeled the impact of eliminating first-dollar coverage, modifying Medicare's cost-sharing requirements, and adding an out-of-pocket limit on beneficiaries' spending.","PeriodicalId":87188,"journal":{"name":"Issue brief (George Washington University. National Health Policy Forum : 2005)","volume":" 845","pages":"1-19"},"PeriodicalIF":0.0,"publicationDate":"2012-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40166640","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