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Risk Adjustment for Health Plans Under ACA: Evaluating, Improving Risk Adjustment Models 27 Aug 2013 | 06:05 pm

Risk adjustment is a key mechanism to ensuring appropriate payments for Medicare Advantage plans, Medicare Part D drug plans, and Medicaid health plans.  Since health plans vary in their mix of health...

Medicare Spending, Beneficiaries, Providers, Health Plans, and Drug Plans: MedPAC Data Book for 2013 26 Aug 2013 | 06:07 pm

Medicare will spend $598.4 billion on health care services for seniors and the disabled in 2013 and about $635 billion in 2014.  Medicare expenditures will top $1 trillion in 2021, according to CMS ac...

Multi-Payor Medical Homes: Actions to Limit Anti-Trust Liability 21 Aug 2013 | 06:38 pm

Multi-payor medical home initiatives have many benefits. They can bring Medicare, Medicaid, and private health plans together to promote care coordination, better health outcomes, and lower costs. But...

Individual Health Insurance Market under ACA: Lessons from Medicare Part D 20 Aug 2013 | 05:15 pm

The individual health insurance market undergoes dramatic changes in 2014 under the Affordable Care Act, especially for health plans offering coverage through the new Health Insurance Exchanges.  The ...

Hospital Costs: Handful of Conditions Account for Half of Hospital Costs 19 Aug 2013 | 05:01 pm

Hospital costs are of keen interest to Medicare, Medicaid, and private health insurers these days, who pay the vast majority of hospital costs. Which services are the most expensive? Which types of he...

Smoking Cessation Coverage for Pregnant Women in Medicaid and Health Insurance Exchanges 16 Aug 2013 | 11:34 pm

The Affordable Care Act (ACA) coverage expansions to childless adults, through Medicaid and Health Insurance Exchanges, could have broad effects on public health. A recent study gives us one good exam...

Geographic Variation in Health Care Spending and Medicare Payment Reform 30 Jul 2013 | 06:31 pm

In the ongoing struggle over wasteful health care spending, geographic cost variation is a veteran hot topic. The fact that public programs and private health plans spend more for providers in some re...

Military Health Care: Health Professional Contracting and Coordination 29 Jul 2013 | 10:04 pm

The Department of Defense contracts with more than 11,000 health care professionals, at an annual cost of about $1 billion. A recent Government Accountability Office report says the military could do ...

Medicaid Accountable Care Organizations: Provider Capabilities and State Supports 29 Jul 2013 | 07:01 pm

Though most commonly associated with Medicare, Accountable Care Organizations are now making their way into state Medicaid programs. Providers, of course, are an essential part of the ACO model. But m...

Shared Savings: Most Popular Model, Best Practices for Accountable Care Organizations 27 Jul 2013 | 08:12 pm

Even as Accountable Care Organizations and other payment reform models become more common, there is still not much comprehensive information about which models providers participate in most often, and...

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