Healthcare Reform Blog

Fresh U.S. healthcare insights from expert analysts on Healthcare Reform, ACOs, Exchanges, Medicaid, Medicare, regional and national trends…and much more
Chris LewisContributor: Chris Lewis
Topics: Covered California, American Cancer Society Cancer Action Network, Fingertip Formulary, Decision Resources Group

When Covered California first opened for business in 2014, comparing qualified health plans by the drugs they cover was an exercise in frustration.

As outlined in my reform blog a year ago, the public insurance exchange site did not provide readily available formulary information. Some health plans posted the exchange formularies on their websites, but they were difficult to distinguish from other plan drug lists, and the lack of standardization made the lists difficult to navigate and compare.

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Posted on: 10/16/2014 4:12:29 PM

Courtney SnellContributer: Courtney Snell
Topics: ACOs, Pioneer ACOs, Medicare

In the courtroom of public opinion, it’s been a rough couple of weeks for the Centers for Medicare & Medicaid Services and its ACO model. On the coattails of the Medicare Shared Savings Program results came the similarly mixed and disparate performance of the Pioneer ACOs, introducing more questions about the long-term durability of a model that has now lost close to half of its participants. Right now, there is little evidence as to whether Pioneer ACOs are truly pioneering the way healthcare is being delivered and reimbursed. Read more.
Posted on: 10/15/2014 10:14:14 AM

Contributer: Laura Beerman
Topics: ACOs, Pioneer ACOs, Medicare

And another three bite the dust. Following the nine departures from CMS’s Medicare Pioneer ACO program last summer and Sharp HealthCare’s exit in August, Genesys PHO, Franciscan Alliance and Renaissance Health Network have bid adieu to CMS’s brand of accountable care. Predictions are swirling on the program’s demise. But before your local pundit stands on the corner with a sandwich board crying the “The end is nigh,” it’s worth looking at why the Pioneers left and how more departures might be prevented. Read more.
Posted on: 10/2/2014 11:40:16 AM

Bill MelvilleContributor: Bill Melville
Topics: ACOs, Medicare, Texas

Accountable care organizations in Texas were responsible for a large cut of the dollars saved by the Medicare Shared Savings Program thus far. Not all Texas ACOs saved money, but the ones that did indicate that accountable care could have staying power in unexpected places.
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Posted on: 10/1/2014 3:31:19 PM

Joyce CaruthersContributor: Joyce Caruthers
Topic: Medicaid, Healthcare Reform, Health Insurance Exchanges, Hospital reimbursement

Industry insiders predicted an increase in Medicaid enrollment in states that did not expand Medicaid eligibility under healthcare reform, but so far, that forecast hasn’t panned out.

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Posted on: 9/26/2014 3:46:31 PM

Jane DuboseContributor: Jane Dubose
Topic: ACOs, Pioneer ACOs, Sharp HealthCare

It’s hard even for the most ardent of optimists to find many silver linings in the new data from the federal government on the financial and quality performance of Medicare accountable care organizations. Created by the 2010 Affordable Care Act, the Medicare ACO experiment has been widely seen as one of the most significant shifts in healthcare delivery in the last few decades. Read more.
Posted on: 9/25/2014 1:36:00 PM

Bill MelvilleContributor: Bill Melville
Topics:, Nevada Health Link, MNSure, Affordable Care Act

As difficult as the launch of was initially, it was a smoother ride than many state-run public health insurance exchanges. Facing mounting costs and uncertainty, state-run exchanges may become a rarity, if not in 2016, then the not-so-distant future.
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Posted on: 9/18/2014 10:37:42 AM

Deborah WhiteContributor: Deborah White
Topics: CVS/MinuteClinic, Texas Health Resources, Baylor Health Care System, Walgreens’ Healthcare Clinics, Seton Healthcare Family, RediClinic, Rite Aid

Three health systems in Texas have new affiliations with retail drug stores this year as part of a strategic focus on population health management and accountable care organizations.  At first glance, the affiliations may seem odd especially now that retail clinics are offering more primary healthcare services. Wouldn’t the clinics be considered a competitive threat?
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Posted on: 9/16/2014 4:17:38 PM

Bill MelvilleContributor: Bill Melville
Topics: Mergers/acquisitions, ACOs, Healthcare reform, Health system consolidation, Affordable Care Act

A few months back, Banner Health’s recent expansions into outlying parts of the Phoenix metro area pointed in an intriguing direction: Tucson. Despite the possible stepping stone of purchasing Casa Grande Regional Medical Center between Phoenix and Tucson, it wasn’t clear how Banner would enter the southern Arizona market.
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Posted on: 9/8/2014 8:57:38 AM

Lyda PhillipsContributor: Paula Wade
Topic: UnitedHealth Group, exchanges, Alabama, Florida, Mississippi, Nevada, Texas

The nation’s largest private insurer, UnitedHealth Group, is jumping into the public insurance exchange market in 2015—heightening competition in at least 15 states in which it plans to compete for individual business.

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Posted on: 9/4/2014 5:17:31 PM

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