Healthcare Business Week in Review: Children’s Health Coverage, ACOs, Reducing ED Visits

Friday, January 10th, 2014
This post was written by Cheryl Miller

Some good news to welcome in the new year: nearly two-thirds of the nation’s leading healthcare executives believe the healthcare system will be somewhat or significantly better by 2020 than it is today as a result of national healthcare reform, according to a study published in the Health Affairs blog.

Additionally, 93 percent believe that the quality of care provided by their own hospital or health system will improve during that time period. The findings, based on research by the University of Pennsylvania and the Children’s Hospital of Philadelphia, includes responses from 74 senior executives from large hospitals and health systems across the United States.

More good news: doctors, hospitals and other healthcare providers have formed 123 new Medicare ACOs, providing approximately 1.5 million more Medicare beneficiaries with access to high-quality coordinated care across the United States.

According to a CMS announcement, the new ACOs include a diverse cross-section of healthcare providers across the country, including providers delivering care in underserved areas. More than half of ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries. Approximately one in five ACOs include community health centers, rural health clinics, and critical access hospitals that serve low-income and rural communities, CMS said.

Good news extends to low-income children as well, with our report that 23 states received over $307 million in bonuses for improving access to children’s health coverage and successfully enrolling eligible children in Medicaid, according to CMS.

States that met at least five out of eight specific features to streamline enrollment, including using data-matching to reduce paperwork and eliminating face-to-face interview requirements, received performance bonuses, designed to offset the costs of insuring this demographic, and initiated by The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Some news to ponder: contrary to the idea that convenience prompts many privately insured people to seek care in emergency departments (EDs), those most likely to use EDs believe they urgently need medical attention, according to a new study by the Center for Studying Health System Change (HSC).

Only rarely did respondents cite convenience as a reason for choosing ED care. About one in four people (24.8 percent) reported their doctor’s office was closed when they needed help, and close to a quarter (24.1 percent) indicated their physician instructed them to go to an ED.

Wondering what healthcare industry areas are ripest for expansion in 2014? Check out our latest HINfographic: 7 Value-Based Priorities for Healthcare’s Smart Money, based on the latest HIN market research.

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