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Archive for accountable care organization

 

A New Approach to Serving High-Cost, High-Need, High-Risk Medicaid Patients

A partnership consisting of a county government, a public hospital, a county-run Medicaid managed care plan, and a federally qualified health center, Hennepin Health is an accountable care organization that seeks to serve high-cost, high-need, high-risk Medicaid patients in the greater Minneapolis area. Hennepin Health targets such individuals – all childless adults who became eligible for Medicaid when the state expanded its Medicaid program in 2011 – with the help of algorithms, identifies those most likely to incur high medical costs. It then offers a blend of social services, preventive care, and other services to address members’ medical conditions while [&hellip

Docs Less Likely to Participate in ACOs in Disadvantaged Communities

A new study has found that physicians who practice in areas with higher proportions of low-income, uninsured, less-educated, disabled, and African-American residents are less likely than others to participate in accountable care organizations. If ACOs ultimately are found to improve health care quality while better managing costs, their benefits might be limited in such communities, thereby exacerbating health care disparities. It also would be disadvantageous to many of the communities served by the nation’s private, non-profit urban safety-net hospitals. To learn more, go here to see the Health Affairs report “Physicians’ Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More [&hellip

Medicare ACOs Showing Promise Among Clinically Vulnerable

A new study has found that Medicare patients with multiple acute or chronic medical conditions who are served by accountable care organizations cost less to serve and visit hospital emergency rooms less frequently. Such patients also had fewer ambulatory care-sensitive hospital admissions and 30-day hospital readmissions. The study, published in JAMA Internal Medicine, traced the reduction in costs to providers making less use of institutional settings when treating their clinically vulnerable patients. To learn more about the study and its potential implications for both taxpayers and the 23 million Americans enrolled in more than 700 ACOs, go here to see a report from [&hellip

Background Information on Payment Methodologies and Benefit Design

The Urban Institute has issued two new papers with background information on health care payment methodologies and the design of health care benefits packages. The first paper, Payment Methods: How They Work, describes nine payment methodologies: fee schedules primary care capitation per diem payments to hospitals for inpatient visits DRG-based payments to hospitals for inpatient visits global budgeting for hospitals bundled payments global capitation for organizations shared savings pay for performance The second paper, Benefit Designs: How They Work, explains seven different types of benefit designs: value-based design high-deductible health plans tiered networks narrow networks reference pricing centers of excellence benefit design [&hellip

Medicare Hits Payment Target

Medicare has achieved its goal of tying 30 percent of all Medicare payments to alternative payment models a year early, the Centers for Medicare & Medicaid Services has announced. As of January of 2016, 30 percent of Medicare payments are tied to alternative payment models. In January of 2015, Health and Human Services Secretary Sylvia Mathews Burwell announced the target but said she hoped Medicare could achieve it by 2017. Among the alternative care models to which Medicare payments are now tied are: Medicare Shared Savings Program (MSSP) Pioneer ACOs Next Generation ACOs Comprehensive End Stage Renal Disease (ESRD) Care [&hellip

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