News Clips
Health Affairs (10/28) The ACA Did Not Increase Spending Growth, So We Can Expand Coverage Further – The ACA itself contained underappreciated cost-control aspects. ACOs surely had an impact, albeit a small one. ACA Medicare payment changes (particularly readmission penalties and market basket update reductions, and the inexorable (if slow) overall push to value-based payments focused attention on cost reduction strategies across the health care system to an unprecedented degree. To realize the promise of ACA universal coverage, we need effective polices to control costs and marginally move our lumbering system toward value-based care. We must further develop these models. Value-based payment has progressed more than it feels to many of us, but we still live largely in a revenue-maximizing health care system built on a fee-for-service payment edifice.
American Economic Liberties Project (10/24) America’s Health Care Consolidation Crisis: A Ledger of Harms and Framework for Advancing Economic Liberty for All – Consolidation has failed to deliver its purported clinical and administrative benefits. The United States spends nearly twice as much on health care as other countries, with far worse outcomes and vast disparities. Our caretaking workforce is both overworked and underpaid, and the system’s profits increasingly flow to health care rent seekers and middlemen. The American Economic Liberties Project has compiled a ledger of harms to chronicle the research showing both the extent of health care’s concentration crisis and how it hurts patients, providers, and other market participants. It also offers several policy suggestions for restoring healthy competition.
Modern Healthcare (10/22) How surprise billing arbitration strains physician groups – Physician groups have filed hundreds of complaints with the federal government and sued insurers to collect overdue payments stemming from the dispute resolution process established by the No Surprises Act of 2022. In just one example, an orthopedic physician practice in New Jersey recently sued Cigna, alleging the insurer has not paid a $42,000 dispute settlement in the 30-day period required by the law. The lawsuit adds to a growing list of questions around the No Surprises Act's implementation, including a disagreement among federal courts on whether organizations are compelled to pay arbitration determinations. As physician groups wait for a resolution, their declining financial position has stoked care access concerns.
Med City News (10/22) Can Primary Care Thrive Outside of Traditional Healthcare Players? – Recent failures in the retail health space beg the question: Is primary care only suited to remain within traditional players, such as health systems, physician practices and large employers? Four health care executives shared their responses to this question during a Sunday panel at HLTH in Las Vegas. Ananya Banerjee, chief commercial officer at Aledade, agreed that primary care can exist outside of traditional settings.“ So many [disruptors] have struggled because it’s hard to survive in a pure fee-for-service model. When you figure out what the right payment model is, that’s when you figure out how to thrive. And that’s what we try to do at Aledade — helping independent [primary care providers] transition from fee-for-service to value-based care,” Banerjee declared.
AMA (10/11) Accelerating the adoption of value-based care– The shift to value-based care (VBC) is happening rapidly. Whether through innovative new team-based care models or more traditional Accountable Care Organizations (ACO) relationships, patient care focused on value is reshaping current medical practice. Current Procedural Terminology (CPT®) codes provide a foundation to support the success of VBC models. These insights were identified through landmark research conducted by the AMA, in collaboration with Manatt Health, to understand the CPT code set’s role in VBC. This research, coupled with AMA-developed educational content, best practices and playbooks for physicians, creates a suite of content that provides greater context to the nation’s understanding of VBC models and helps physicians broadly adopt innovative VBC models.
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