Archive for the ‘Healthcare Reform’ Category

Infographic: Three Roads to Universal Healthcare Coverage

November 13th, 2017 by Melanie Matthews

There are a number of different paths to universal healthcare coverage, from government-financed and -run approaches to largely employer-financed systems administered by insurance companies, according to a new infographic by The Commonwealth Fund.

The infographic examines three of these paths.

Trends Shaping the Healthcare Industry in 2018: A Strategic Planning SessionUncertainty regarding the future of the Affordable Care Act (ACA), combined with industry market forces, including consolidations and strategic partnerships, positioning for value-based healthcare, cost containment efforts, an emphasis on technology and efforts to understand and address the whole patient as part of population health management have been the key drivers in the healthcare industry this year.

With the efforts to repeal and replace the ACA now focused on the elimination of the cost-sharing reduction (CSR) payments to insurers and changes to regulations governing association health plans, short-term, limited-duration insurance and health reimbursement arrangements, the healthcare industry can put aside the uncertainty of this year and move forward with the market forces in play.

During Trends Shaping the Healthcare Industry in 2018: A Strategic Planning Session, a 60-minute webinar on December 7th, two industry thought leaders Cynthia Kilroy, principal at Cynthia Kilroy Consulting and Brian Sanderson, managing principal, healthcare services, Crowe Horwath, will provide a roadmap to the key issues, challenges and opportunities for healthcare organizations in 2018.

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Infographic: The ACA’s Innovation Waiver Program

November 10th, 2017 by Melanie Matthews

Under the Affordable Care Act (ACA), states can pursue “innovation waivers,” sometimes known as 1332 waivers, as of 2017. These waivers allow states to modify key parts of the law, so long as they stay true to its goals and consumer protections, according to a new infographic by the Commonwealth Fund.

The infographic provides a state-by-state look at innovation wavers.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations Asked by its C-suite to quantify contributions of its multidisciplinary care team for its highest-risk patients, AltaMed Health Services Corporation readily identified seven key performance metrics associated with the team. Having demonstrated the team’s bottom line impact on specialty costs, emergency room visits, and HEDIS® measures, among other areas, the largest independent federally qualified community health center (FQHC) was granted additional staff to expand care management for its safety net population.

The Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations chronicles AltaMed’s four-phase rollout of care coordination for dual eligibles—a population with higher hospitalization and utilization and care costs twice those of any other population served by AltaMed.

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Infographic: The Impact of Cost-Sharing Reduction Payments on Insurance Markets

November 6th, 2017 by Melanie Matthews

The loss of cost-sharing reduction (CSR) payments in the health insurance marketplaces would destabilize insurance markets and add to the federal deficit, according to a new infographic by NEJM Catalyst.

The infographic examines the impact of ending the CSR payments on premiums of silver plans on the exchange as well as for Medicaid expansion and non-expansion states and the impact on the federal deficit through 2026.

Trends Shaping the Healthcare Industry in 2018: A Strategic Planning SessionUncertainty regarding the future of the Affordable Care Act (ACA), combined with industry market forces, including consolidations and strategic partnerships, positioning for value-based healthcare, cost containment efforts, an emphasis on technology and efforts to understand and address the whole patient as part of population health management have been the key drivers in the healthcare industry this year.

With the efforts to repeal and replace the ACA now focused on the elimination of the cost-sharing reduction (CSR) payments to insurers and changes to regulations governing association health plans, short-term, limited-duration insurance and health reimbursement arrangements, the healthcare industry can put aside the uncertainty of this year and move forward with the market forces in play.

During Trends Shaping the Healthcare Industry in 2018: A Strategic Planning Session, a 60-minute webinar on December 7th, two industry thought leaders Cynthia Kilroy, principal at Cynthia Kilroy Consulting and Brian Sanderson, managing principal, healthcare services, Crowe Horwath, will provide a roadmap to the key issues, challenges and opportunities for healthcare organizations in 2018.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: Healthcare Payment Model Reform

November 3rd, 2017 by Melanie Matthews

As the 79 million baby boomers turn 65, they will grow the
Medicare-eligible cohort from 13.1 percent to 20.3 percent in 2030, according to a new infographic by HORNE Healthcare.

The infographic provides advice for providers to prepare for success in the ever-changing healthcare reimbursement environment.

Under CMS’s “Pick Your Pace” choices for Year 1 Quality Payment Program participation, physician practices may opt for the minimum activity necessary to avoid a payment penalty in 2019 by simply submitting some data in 2017.

However, instead of delaying MACRA participation to the later part of this year, physicians should prepare and better position themselves today for MIPS success by analyzing their existing CMS data on their practices’ performance and laying a path now toward performance improvement.

Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance describes the wealth of data analytics available from the CMS Enterprise Portal–Quality Resource Use Reports (QRURs) and other reports providing a window into practice performance under the Merit-Based Incentive Payment System (MIPS). MIPS is one of two MACRA reimbursement paths and the one where most physician practices are expected to align.

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2016 ACO Results: Majority of Next Generation and Pioneer ACOs Earn Shared Savings

October 20th, 2017 by Patricia Donovan

Six of eight Pioneer ACOs and eleven of eighteen Next Generation ACOs earned shared savings in separate initiatives in 2016, according to newly released quality and financial data from the Centers for Medicare and Medicaid Services (CMS).

In 2016 Performance Year Five of the Pioneer ACO program, one of several new accountable care organization (ACO) payment and service delivery models introduced by CMS to serve a range of provider organizations, only Monarch HealthCare and Partners HealthCare were not among shared savings earners.

Banner Health Network emerged as the top 2016 Pioneer ACO performer, earning nearly $11 million in shared savings based on care provided to its more than 42,000 beneficiaries.

In order to receive savings or owe losses in a given year, Pioneer ACO expenditures must be outside a minimum corridor set by the ACO’s minimum savings rate (MSR) and minimum loss rate (MLR).

The Pioneer ACO model is designed for healthcare organizations and providers already experienced in coordinating care for patients across care settings. It allowed these provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with but separate from the Medicare Shared Savings Program (MSSP).

The Pioneer ACO Model began with 32 ACOs in 2012 and concluded December 31, 2016 with eight ACOs participating.

Meanwhile, at the conclusion of 2016 Performance Year One of the Next Generation ACO model, Baroma, Triad and Iowa Health topped the list of ACO earners in this program, with each organization accumulating more than $10 million shared savings.

Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program, CMS’s Next Generation ACO Model sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care.

According to a CMS fact sheet, 18 ACOs participated in the Next Generation ACO Model for the 2016 performance year, and 28 ACOs are joining the Model for 2017, bringing the total number of Next Generation ACOs to 45. The Next Generation ACO Model will consist of three initial performance years and two optional one-year extensions.

CMS’s ACO models are one of seven Innovation categories designed to incentivize healthcare providers to become accountable for a patient population and to invest in infrastructure and redesigned care processes that provide for coordinated care, high quality and efficient service delivery.

President Trump Halts CSR Payments, Signs Executive Order on ACA Components

October 12th, 2017 by Melanie Matthews

The Trump Administration has called for the discontinuation of cost-sharing reductions (CSR) payments to health insurance companies based on a legal opinion from the Attorney General. President Trump also signed three executive orders directing the appropriate federal agencies to examine three Affordable Care Act (ACA) components: association health plans (AHPs), short-term, limited-duration insurance (STLDI), and health reimbursement arrangements (HRAs).

“CSR payments are prohibited unless and until a valid appropriation exists,” said HHS Acting Secretary Eric Hargan, referring to the legal opinion from the Attorney General’s Office regarding CSR payments.

According to August 2017 estimates from the Congressional Budget Office and the Joint Committee on Taxation on the impact of ending CSR payments, the number of people uninsured will be approximately 1 million higher than under the baseline in 2018 but about 1 million lower in each year starting in 2020. In 2018, under the policy, the largest effect on coverage would derive from the drop in the number of insurers participating in the non-group market.

The CBO and JCT also estimated that by 2020, the effect on coverage would stem primarily from the increases in premium tax credits, which would make purchasing non-group insurance more attractive for some people. As a result, a larger number of people would purchase insurance through the marketplaces, and a smaller number of people would purchase employment-based health insurance.

President Trump also signed Executive Orders that direct the:

  • Secretary of Labor to consider expanding access to AHPs;

  • Departments of the Treasury, Labor, and Health and Human Services to consider expanding coverage through low cost STLDI; and

  • Departments of the Treasury, Labor, and Health and Human Services to consider changes to HRAs.

Each of these components will be subject to the federal government’s rulemaking process and will not have an impact on this year’s open enrollment period under ACA.

Industry reaction was mixed to the Executive Orders:

  • “Health plans remain committed to certain principles. We believe that all Americans should have access to affordable coverage and care, including those with pre-existing conditions. We believe that reforms must stabilize the individual market for lower costs, higher consumer satisfaction, and better health outcomes for everyone. And we believe that we cannot jeopardize the stability of other markets that provide coverage for hundreds of millions of Americans. We will follow these principles – competition, choice, patient protections and market stability – as we evaluate the potential impact of this executive order and the rules that will follow. We look forward to engaging in the rulemaking process to help lower premiums and improve access for all Americans,” said Kristine Grow, Senior Vice President, Communications, America’s Health Insurance Plans (AHIP).

  • The American Hospital Association (AHA) said while the “Executive Order will allow health insurance plans that cover fewer benefits and offer fewer consumer protections. No one can predict future health care needs with complete certainty and such plans could put patients at risk when care is needed most.”

    In addition, said the AHA, these provisions could destabilize the individual and small group markets, leaving millions of Americans who need comprehensive coverage to manage chronic and other pre-existing conditions, as well as protection against unforeseen illness and injury, without affordable options. And, regarding consolidation, respected economic studies demonstrate that the hospital field’s trajectory has resulted in both cost savings and quality improvements. The AHA is encouraging the Administration to achieve the goal of ensuring that individuals and small businesses have affordable, comprehensive healthcare coverage options without sacrificing critical consumer protections by stabilizing the individual and small group markets.

2017 ACO Snapshot: As Adoption Swells, Social Determinants of Health High on Accountable Care Agenda

June 29th, 2017 by Patricia Donovan

Nearly two-thirds of 2017 ACO Survey respondents attribute a reduction in hospital readmissions to accountable care activity.

Healthcare organizations may have been wary back in 2011, when the Department of Health and Human Services (HHS) first introduced the accountable care organization (ACO) model. The HHS viewed the ACO framework as a tool to contain skyrocketing healthcare costs.

Fast-forward six years, and most resistance to ACOs appears to have dissipated. According to 2017 ACO metrics from the Healthcare Intelligence Network (HIN), ACO adoption more than doubled from 2013 to 2017, with the number of healthcare organizations participating in ACOs rising from 34 to 71 percent.

During that same period, the percentage of ACOs using shared savings models to reimburse its providers increased from 22 to 33 percent, HIN’s fourth comprehensive ACO snapshot found.

And in the spirit of delivering patient-centered, value-based care, ACOs have embraced a whole-person approach. In new ACO benchmarks identified this year, 37 percent of ACOs assess members for social determinants of health (SDOH). In support of that trend, the 2017 survey also found that one-third of responding ACOs include behavioral health providers.

Since that first accountable care foray by HHS, the number of ACO models has proliferated. The May 2017 HIN survey found that, of current ACO initiatives, the Medicare Shared Savings Program (MSSP) from the Centers for Medicare and Medicaid Services (CMS) remains the front runner, with MSSP participation hovering near the same 66 percent level attained in HIN’s 2013 ACO snapshot.

Looking ahead to ACO models launching in 2018, 24 percent of respondents will embrace the Medicare ACO Track 1+ Model, a payment design that incorporates more limited downside risk.

This 2017 accountable care snapshot, which reflects feedback from 104 hospitals, health systems, payors, physician practices and others, also captured the following trends:

  • More than half—57 percent—participate in the Medicare Chronic Care Management program;
  • Cost and provider reimbursement are the top ACO challenges for 18 percent of 2017 respondents;
  • Clinical outcomes are the most telling measure of ACO success, say 83 percent of responding ACOs;
  • Twenty-nine percent of respondents not currently administering an ACO expect to launch an accountable care organization in the coming year;
  • 75 percent expect CMS to try and proactively assign Medicare beneficiaries to physician ACO panels to boost patient and provider participation.

Download HIN’s latest white paper, “Accountable Care Organizations in 2017: ACO Adoption Doubles in 4 Years As Shared Savings Gain Favor,” for a summary of May 2017 feedback from 104 hospitals and health systems, multi-specialty physician practices, health plans, and others on ACO activity.

Infographic: Medicaid’s Role in Behavioral Healthcare

May 19th, 2017 by Melanie Matthews

Medicaid restructuring as proposed in the American Health Care Act could limit states’ ability to care for people with behavioral health conditions, according to a new infographic by the Kaiser Family Foundation.

The infographic details how Medicaid currently enables people with behavioral health needs to access care and how reduced federal spending could limit behavioral health coverage and services.

Behavioral Health Patient Engagement: Using Motivational Interviewing Techniques and Strategies To Improve OutcomesAs the critical role of an engaged, activated healthcare consumer becomes more apparent in a value-based healthcare system, healthcare organizations are focusing on patient engagement and activation programs.

In a recent industry survey on trends in patient engagement, healthcare organizations reported that behavioral health conditions presented a particular challenge to patient engagement initiatives. However, there is robust evidence that motivational interviewing is a powerful approach for treating substance abuse, anxiety and depression.

Behavioral Health Patient Engagement: Using Motivational Interviewing Techniques and Strategies To Improve Outcomes, a 45-minute webinar now available for replay, Mia Croyle with the University of Wisconsin School of Medicine and Public Health shares key learnings from patient engagement initiatives targeted at patients with behavioral health conditions.

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Infographic: A Look Back at Healthcare Steps in Trump’s First 100 Days

May 15th, 2017 by Melanie Matthews

In the first 100 days of his administration, President Donald J. Trump has taken a number of actions that could impact healthcare, including filling a Supreme Court seat and taking steps to repeal the Affordable Care Act, according to a new infographic by AJMC.

The infographic examines some of the most notable healthcare-related happenings in Trump’s first 100 days in office.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry Not in recent history has the outcome of a U.S. presidential election portended so much for the healthcare industry. Will the Trump administration repeal or replace the Affordable Care Act (ACA)? What will be the fate of MACRA? Will Medicare and Medicaid survive?

These and other uncertainties compound an already daunting landscape that is steering healthcare organizations toward value-based care and alternative payment models and challenging them to up their quality game.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry, HIN’s 13th annual business forecast, is designed to support healthcare C-suite planning during this historic transition as leaders prepare for both a new year and new presidential leadership.

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Infographic: What Millennials Want From Healthcare

April 24th, 2017 by Melanie Matthews

Millennials are the healthcare wildcard for policy makers, insurers, healthcare providers and employers, according to a new infographic by Benenson Strategy Group.

The infographic explores whether Millennials will redefine healthcare based on their unique experiences, attitudes and viewpoints or engage more predictably with the healthcare industry based on a lifecycle model.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry Not in recent history has the outcome of a U.S. presidential election portended so much for the healthcare industry. Will the Trump administration repeal or replace the Affordable Care Act (ACA)? What will be the fate of MACRA? Will Medicare and Medicaid survive?

These and other uncertainties compound an already daunting landscape that is steering healthcare organizations toward value-based care and alternative payment models and challenging them to up their quality game.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry, HIN’s 13th annual business forecast, is designed to support healthcare C-suite planning during this historic transition as leaders prepare for both a new year and new presidential leadership.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.