Noteworthy News

Archive for November, 2015


Push From Volume to Value Continues

As the end of 2015 nears, CMS has used its blog to reflect on its continued efforts to move the U.S. health care system from one that pays for the volume of care provided to one that pays for the value of that care. The blog notes the replacement of the sustainable growth rate (SGR formula) with a new payment system that better supports patient-centered care; the creation of the Home Health Value-Based Purchasing model; and the introduction of Medicare reimbursement for advance care planning. The blog also describes the many programs launched by the Affordable Care Act-created Center for [&hellip

Feds Seek to Regulate Narrow Networks

Amid concerns that low-cost health plans are reducing their provider networks to contain costs at the expense of access to care for their members, the Centers for Medicare & Medicaid Services (CMS) is proposing new guidelines to limit how much those provider networks can be narrowed. According to a CMS fact sheet, To protect consumer access to health care providers and delivery organizations, the proposal asks states to establish a provider network adequacy standard for health plans in the federal Marketplace, subject to minimum criteria that CMS will establish at a later date, with a default time and distance standard [&hellip

OIG Reveals 2016 Plans

The U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) has published its work plan for the 2016 fiscal year. In 2016, the OIG will continue to examine all aspects of HHS endeavor, including Medicare, Medicaid, hospital services, public health activities, and more. In the coming year it will continue a number of hospital-focused projects while also focusing more on health care delivery, health care reform, alternative payment methodologies, and value-based purchasing initiatives. Among the OIG’s planned Medicare projects in 2016 – some of them continued from the past and some of them new, quoted directly from [&hellip

Feds OK Medicaid Money for Housing

The Obama administration has informed state Medicaid programs that they may use federal Medicaid money to help the chronically homeless obtain housing. While a June bulletin to state Medicaid directors technically only clarified existing policy, it signaled states that the administration will be receptive to Medicaid waivers that propose using Medicaid funding to help the homeless obtain housing. Increasingly, state Medicaid programs have been finding that helping the homeless with housing is a key to improving their physical and behavioral health and can offer later savings as the individuals who have received such assistance live more stable lives, especially as [&hellip

Study Looks at Social Determinants of Health

A new issue brief from the Kaiser Family Foundation looks at the social determinants of health and health outcomes. The issue brief “Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity” reports that Social determinants have a significant impact on health outcomes. Social determinants of health are “the structural determinants and conditions in which people are born, grow, live, work and age.” They include factors like socioeconomic status, education, the physical environment, employment, and social support networks, as well as access to health care (Figure 2). Based on a meta-analysis of nearly 50 studies, researchers [&hellip

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