Hidden Benefits: The Value of Medicaid Managed Care
Sept - 15
As states increasingly look to risk-based managed care to serve the majority of Medicaid beneficiaries, they are also looking for new and innovative ways to ensure that beneficiaries have access to the full array of services needed to keep them healthy. Traditional measures of “network adequacy” – including physician-to-enrollee ratios and time/distance requirements – are important, but they paint an incomplete picture of how Medicaid managed care plans, working with their provider and state partners, enhance network access and delivery of high quality care for their members through innovative network-enhancing strategies.
The Continued Need for Reform: Building a Sustainable Health Care System
Sustainable health care reform must address cost and quality, while expanding coverage through a vibrant and functional marketplace. We are focused on fixing what's broken in our health care system while preserving what works, and we are leading efforts to implement an affordable and quality delivery system for all Americans for the 21st century. We believe there is a continued need for reform in improving health care quality, which can help manage costs; implementing insurance market reforms that ensure a vibrant, functional marketplace; and ensuring that public and private rates for services and coverage reflect true costs.
The Facts About Health Insurer Profits
In the on-going debate over how to address the rising cost of health care many people point to a perceived need to reduce health insurer profits, erroneously believing that doing so will significantly reduce the cost of health insurance. Click for full story
The Way We Pay for Health Care.
Unsustainable health care cost trends have state and federal policymakers exploring ways to align provider payment to improve quality and ensure appropriateness of care without jeopardizing affordability. Some of the more popular options include pay-for-performance models, reimbursement for episodes of care, value-based purchasing and global payments. This article explores these options and their potential for increasing value while helping control costs. Click for full story
The 2009 Health Information Technology For Economic and Clinical Health Act
The Health Information Technology for Economic and Clinical Health Act (HITECH) is an important component of the federal economic stimulus package enacted by Congress in early 2009. Designed to promote the widespread adoption of health information technology (HIT), the Act is considered a crucial part of the health reform process. The implementation of health information technology, however, goes beyond electronic medical records. This article explains key provisions of the Act and offers insights into aspects of its implementation that will require careful consideration. Click for full story
Challenges Associated with Government-Run Plans
A number of proposals for health reform include a government-run health plan, described by proponents as an additional option for coverage in the private marketplace for employers and consumers. In reality, such a plan could result in significant challenges and unintended consequences. This article discusses how a government-run plan would impact private coverage, consumer choice, cost of coverage, quality, barriers to access and incentives that ultimately increase costs and reduce coverage. Click for full story
What's Really Driving the Increase in Health Care Premiums?
Although the rate of increase has slowed in recent years, the cost of health care services and premiums continues to rise and is a major concern to individuals, employers and the government. The escalation of costs accounts for the overwhelming impetus behind calls for health care reform. Yet most people don't understand what drives health care premiums. For meaningful health care reform to occur, policymakers will need a clear and accurate understanding of the real (vs. perceived) factors that are actually driving the cost increases... Click for full story
When it comes to health care reform we should not just get it done, we should get it done right
The urgency of the health care crisis in today's economy calls for thoughtful, sustainable solutions. The strength of any health care reform plan will be measured by the sum of its parts. We believe that an essential ingredient for practical and sustainable health care reform is improving health care quality, which can help manage costs. And while improving quality and reducing costs is the key to a better system, we must also get our country on a sustainable path to covering everyone. Click for full story
Patient Safety is a National Health Policy Priority
Preventable medical errors cause as many as 98,000 deaths each year. Accountability for improving patient safety rests with hospitals, medical facilities, payors, the government, and public-private partnerships. Measures including nationally standardized reporting systems, non-payment policies for certain medical errors, and institution of best practice improvement programs will all play a role in combating errors and improving safety. Click for full story
Expansion of Existing Public Health Insurance Programs One Way to Help Increase Coverage for the Uninsured
Although recent census bureau numbers show the number of uninsured is decreasing, the rate of those without coverage remains high. Public programs are an important part of any initiative to reduce the rate of uninsured. Click for full story
Anti-Smoking and Other Lifestyle-Based Initiatives Key in Addressing Public Health
As unhealthy behaviors have become more prevalent in the U.S. and chronic medical conditions associated with unhealthy lifestyle choices increase, health care costs also continue to rise. Initiatives targeted at supporting healthy lifestyle choices, coupled with incentives for making and maintaining those choices, will be key to addressing health improvement. Click for full story
Pay for Performance Programs Offer a Means toward Improving Health Care Delivery and Reducing Inefficiencies in Care
The traditional way of reimbursing health care providers is by quantity: the more patients a provider sees and the more tests and services provided to each patient, the higher the compensation. Pay for performance programs reward providers for furnishing higher-quality health care. The better the provider's performance, the higher his or her incentive bonus payment or promotion via public reporting will be. Click for full story
Health Plan Administrative Costs Have Increased at Substantially Lower Rates than Health Care Costs
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Information on the Comparative Effectiveness of Alternative Treatments Can Aid in Improving Health Quality and Controlling Health Care Spending
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Expansion of HSAs Could Be One Way to Extend Coverage to the Uninsured Through the Private Market
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Credible Tools for Quality, Outcomes and Pricing Data Needed to Inform Consumer Decision-Making and Support a High-Quality,Knowledge-Based Health Care System
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