Several insurers in Arizona will eliminate their PPO plans, focusing instead on HMO plans in an effort to cut losses associated with taking on more high-risk, high-cost patients, according AZCentral. In 2014, insurance companies reported losses of ranging from $16 million to $90 million in the individual market.
This Deseret News editorial focuses on the possibility of healthcare transformation and overall economic development in the state of Utah. The author praises the collaborative work between different stakeholders to continue their work in value-based care and other progressive health transformation ideas in the state.
Slightly less than half of the hospitals in Southeast Michigan earned positive margins on Medicare, according to a Crain's analysis of IRS Form 990 reports and hospital interviews. Although hospitals have improved efficiency and quality over the past decade; payment reductions, financial penalties for inappropriate hospital readmissions and overbilling have caused Medicare hospital margins to drop to negatives nationally from an average positive 2 percent margin in 2002.
Massachusetts is unique in their commitment to tracking statewide health spending but the state will miss a self-imposed annual healthcare spending target, according to public radio station WBUR. A report from Attorney General Maura Healey finds little change in problems that have been contributing to high costs for years: some hospitals are paid a lot more than others, patients prefer the expensive hospitals and efforts to change the way we pay for healthcare have not yet done much to shift spending.
Older Korean American patients may have significant disparities in preventable hospitalizations, which suggests poor access to or poor quality of primary healthcare, according to an article in Preventing Chronic Disease. Improving primary care for Korean Americans may prevent unnecessary hospitalizations, improve quality of life for Korean Americans with chronic illness, and reduce healthcare costs.
Most D.C. residents who buy health insurance through the District’s online marketplace will see 4 percent premium increases in 2016, compared to Maryland, where the most popular plan will cost on average 26 percent more starting in January 2016, according to The Washington Post.
As medical practices transform to patient-centered medical homes (PCMHs), it is important to identify the ongoing costs of maintaining these “advanced primary care” functions. A key required input is personnel effort. This Annals of Family Medicine study assessed direct personnel costs to practices associated with the staffing necessary to deliver PCMH function in Colorado ($9,658 per month) and Utah ($7,691 per month). Identifying costs of maintaining PCMH functions will contribute to effective payment reform and to sustainability of transformation. Maintenance and ongoing support of PCMH functions require additional time and new skills, which may be provided by existing staff, additional staff, or both. Adequate compensation for ongoing and substantial incremental costs is critical for practices to sustain PCMH functions.
This NYSHealth-funded report, prepared by the APCD Council, examines the issues related to the development of regulations and policies for an all-payer database (APD) in New York State. It also offers recommendations for State policymakers on the choices before them and seeks to preserve an expansive vision for the APDand the extent of its powers. The report captures lessons learned from other states that have developed, or are developing, similar systems and highlights the perspectives of key stakeholders in New York.
Louisiana’s market experienced the largest drop in the country in competition among commercial insurers between 2010-2013, according to an analysis by the AMA featured in Becker’s Hospital Review. Louisiana also ranked in the 10 least competitive HMO and PPO markets in the United States.
Crains Detroit Business: Michigan's 12 accountable care organizations (ACOs) fared better than national averages in saving Medicare money, generating profits of their own and improving quality, according to data for 2014 from CMS and interviews with ACO executives. The article does not assess why this group did so well.