ACA, exchanges, navigators, exchange outreach
Even today, the biggest surprise among health exchanges sounds out of place among states with the highest enrollment—California, Florida, Texas, New York, and (drumroll) North Carolina.
Posted on: 3/28/2014 1:19:30 PM
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Accountable care organizations
ACO formation is on fire in Northern New Jersey. In the first half of March alone, three new accountable care organizations have popped up in the 14-county Northern New Jersey healthcare market, bringing the region’s total number of ACO contracts to 27.
Posted on: 3/25/2014 9:39:35 AM
| with 2 comments
Contributor: Lyda Phillips
Topic: Hospitals, Mergers
The Boston healthcare market is consolidating so rapidly it resembles a game of musical chairs. No health system in this large and lucrative market wants to be the last one standing, without partners, without affiliations, without the vital referral patterns that keep their flagship urban teaching hospitals’ beds filled. Nailing down these critical relationships will cushion the impact of shared risk as global payment contracting takes over as the dominant model in Massachusetts.
Posted on: 3/21/2014 11:48:48 AM
Contributor: Jenny Kerr
Topic: Proton Therapy Centers
In recent years, health systems have turned to development of high-dollar cancer treatment centers to build brand identity as first-rate research facilities and to capture a larger portion of a lucrative market. But the realities of a payer system in transition are forcing health systems to rethink that strategy and could force a move to collaborative efforts with competitors. Insurers are starting to question the effectiveness of the treatment given the associated high cost.
Posted on: 3/19/2014 3:32:27 PM
Medicaid, Exchange Innovation
When the state of Arkansas broached its private model for Medicaid expansion, it held up as a potential roadmap for partnerships between states hesitant to expand their Medicaid programs. But the second-state to follow that course, Iowa, is emerging as the bellwether for market innovation.
Posted on: 3/17/2014 11:25:41 AM
Contributor: Paula Wade
Topic: ACA, employer mandate, exchanges
In his recent waffling over crucial ACA policy elements, President Obama has hurt exchange participation and has endangered—perhaps lost—his credibility with the one group he most needs to make Obamacare a success: the insurers themselves.
Posted on: 3/14/2014 3:29:02 PM
Employers, ACA, Cadillac Tax, consumer-driven health plans, member engagement
Listening to the nation’s largest employers share their anxieties and strategies over the rising cost of healthcare at the National Business Group on Health conference would be a sobering experience for any healthcare consumer. By the next decade, many of us are going to be enrolled in health plans that demand us to carefully scrutinize every decision we make and each dollar we spend. More of us will be responsible for up to $6,000 in out-of-pocket costs before real coverage kicks in.
Posted on: 3/13/2014 2:59:25 PM
Contributor: Mark Cherry
Topics: Narrow networks, ACA, M&A
For health systems that enjoy a dominant market share within their region and have a clinically integrated physician organization, the choice going forward is relatively clear: develop your own narrow-network health plan, either on your own or with a partner MCO. But second-place health systems, particularly in mid-major markets, are reaching a crossroads, with the choices of: merging with a nonprofit health system, being acquired by a for-profit hospital chain, or affiliating more closely with a major health plan. Read more.
Posted on: 3/11/2014 9:46:06 AM
Medicaid, ACA, Exchanges
Drama. Intensity. Emotions reaching a boiling point. Characters with murky motives. Debates about how things are going to end. While this sounds like a description of HBO’s hit television drama “True Detective,” it also aptly describes the Medicaid expansion debate still raging across multiple states. “True Medicaid”? Not sure if that’s a TV show anyone wants to air, but it certainly is not lacking for lead characters.
Posted on: 3/10/2014 4:40:44 PM
Two days at DRG’s Managed Markets Summit last week made me smarter about many topics, but a couple stand out: CO-OPs in the exchanges and electronic health records.
Posted on: 3/7/2014 8:37:26 PM