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Health Policy/Reform
ThoughtLeaders: Prognosis for Medicare and Commercial ACOs
A number of pundits are citing the systemic failure of ACOs, after additional Pioneer ACOs announced withdrawal from the program – Where do you weigh in on the prognosis for Medicare and Commercial ACOs over the next several years?”
Republished courtesy of MCOL
Mark Lutes Chair, Board of Directors, Epstein Becker & Green, P.C.
Certainly, if we dial back the rhetoric and the expectations for immediate system -wide transformation, we can expect accountable care organizations to make a contribution […]
Penguins are Jumping…Payment Reform is Leaping!
[callout]…(The) 2014 National Scorecard on Payment Reform tells us 40 percent of commercial sector payments to doctors and hospitals now flow through value-oriented payment methods, defined as payment methods designed to improve quality and reduce waste. This is a dramatic increase since 2013 when the figure was just 11 percent. Suzanne Delbanco, Executive Director of CPR, in the Health Affairs blog.[/callout]
I’ve written before about what economists call “The Penguin Problem” — No one moves unless everyone moves, so no one […]
Swiss Cheese Health Insurance? “Benefits Adequacy” Moves To Front & Center
Swiss cheese health insurance?So, so many holes.
Ending insurance discrimination against the sick was a central goal of the nation’s health care overhaul, but leading patient groups say that promise is being undermined by new barriers from insurers. The Washington Post
In the past year, network adequacy has been one of the hot button issues for Qualified Health Plans (QHPs) in the Federal health insurance exchange. Network adequacy has focused on access to care providers and the narrow networks used […]
Healthcare Transformation: Coping With the Neutral Zone
I’m being asked the same series of questions a lot lately: Do you think the changes occurring in US healthcare are real? Are we truly moving away from rewarding volume of care under fee-for-service (FFS) and toward value-based payment and delivery? Are the changes past the point of no return? Will the economic interests of the powers-that-be prevent real change from happening, just as they have done in the past?
ACOs: We’re NOT There Yet
by Brian Klepper
On The Health Care Blog, veteran analyst Vince Kuraitis reviews a report from the consulting firm Oliver Wyman (OW), arguing that the trend toward reconfiguring health systems to deliver more accountable care is more widespread than any of us suspect.
“The healthcare world has only gotten serious about accountable care organizations in the past two years, but it is already clear that they are well positioned to provide a serious competitive threat […]
ACOs: Are We “There” Yet?
A  recent analysis of the ACO market by Oliver Wyman market suggests we’re well on our way toward being “there”.
My personal take on this report:
Provocative, fresh, thoughtful, well reasoned, expansive — albeit a bit of a stretch
However, I suspect many others will describe it as:Â
Speculative, harebrained, unsupported, overly extrapolative, out-to-lunch, wishful to the point of being woo woo
So now that I hopefully have your attention, what’s this report all about? In a nutshell:Â
The healthcare world has […]
Are Hospital Business Models on a Burning Platform? Not Yet, But It’s Inevitable.
From reading recent headlines, one might easily get the impression that hospitals are resistant — or at least ambivalent — in their pursuit and adoption of accountable care initiatives.
Are Hospitals Dragging their Feet on Accountable Care?
Commonwealth Fund: “only 13 percent of hospital respondents reported participating in an ACO or planning to participate within a year”
KPMG Survey: “(only) 27 percent of [health system] respondents said current business models were either not very or not at all sustainable over the next five […]
Hospitals or Health Plans: Who Do You Trust to “Connect” You with Your Health Records?
Over the past decade, I’ve seen a number of studies asking people whom they trust among various health care stakeholders. Nurses, pharmacists, and doctors always come out at the top. Beyond that:
Trust of hospitals tends to be high (60–80%)
Trust of health plans is at the bottom of the heap (10–20%)
Is this written in stone for the future? I don’t think so…and the dynamics for change are in motion. Please read on.
Here’s the emerging picture I’m seeing:
Hospitals are dragging their feet in […]
The ACO Antitrust Police — Nothing to Do
One of the biggest concerns about ACOs has been their potential to enable market consolidation— that by uniting health care providers the ACO gains market clout and ability to charge higher prices.
While this is a legitimate concern about ACOs, so far it’s not playing out.
Why?
Will Health Plans Want to Contract with ACOs? Maybe, Maybe Not.
On the Perficient Health IT blog, Christel Kellogg writes:
I am hearing that carriers are staying away from ACOs and are not planning on partnering. What have you heard?
This is one of those blip-on-the-radar-screen comments that jarred my attention — and it raises very important questions about industry dynamics.
First, let me expand on the issue. As I’ve written before, there are at least two broad categories of “accountable care initiatives”:
1) Formal Accountable Care Organizations (ACOs) by which care providers contract with Medicare
2) Informal Accountable […]