|
News Clips
American Medical Association: New study shows Medicare Advantage markets lack competition (11/1) – The 2022 edition of Competition in Health Insurance: A Comprehensive Study of U.S. Markets examines Medicare Advantage markets in 380 metropolitan statistical areas (MSAs). Nearly four out of five (79 percent) MSAs had Medicare Advantage markets with low levels of competition and ranked “highly concentrated” according to federal guidelines. Similar to Medicare Advantage, the vast majority (three out of four) of commercial markets at the MSA-level are also ranked “highly concentrated."
Modern Healthcare: CMS makes big changes to Medicare Shared Savings Program (11/1) – CMS will invest in rural and underserved ACOs and introduce more flexibility to the MSSP with the aim of kickstarting stalled enrollment and bridging health equity gaps. The National Association of ACOs cheered CMS’ moves to provide advance shared savings, add a health equity adjustment, factor in ACOs’ past performance to lower their benchmark over time and give ACOs more time before they are forced to take on financial risk. But the trade group decried CMS’ lack of action on the “rural glitch,” under which ACOs no longer benefit from regional adjustments when reducing their spending on assigned patients. The association also criticized CMS for using a prospective projected external factor for ACO benchmarks for their financial spending target and contended that more than a third of ACOs will be harmed by this change.
Med City News: Could value-based care be more than its shortcomings? (10/30) – Regardless of individual interpretations, at the heart of value-based care is the intentional focus to move away from a volume-driven health care system that does not account for quality or outcomes (and zero regard to sky-rocketing costs) to a payment system that is tied to outcomes and quality. Value-based care has provided a platform and a mechanism, where for the first time, health plans, providers and employer groups are sitting around the table with their sleeves rolled up, ready to collaborate and partner. It is not perfect, but it is an alternative to the status quo with each of the health care players sitting on fragmented islands with no incentive to change. It is a journey – a ‘present-continuous’ tense of a concept that is evolving, adapting and being shaped.
Washington Monthly: How Hospital Monopolies Drive Up the Cost of Care (10/30) – Fifty years ago, most hospitals were stand-alone institutions, fixtures of the local community that served as sources of pride as well as medical care. Today, more than half of hospitals are part of regional systems, many of them with a dozen or more hospitals. With the publication of Big Med, the authors David Dranove and Lawton R. Burns offer an exhaustive analysis of the consolidation of U.S. hospitals and the effect it has had on both the cost and quality of health care. The authors argue that there’s no evidence that megasystems are consistently providing higher-quality care than stand-alone hospitals, and they are no less wasteful, and certainly no less expensive, than smaller institutions. Neither vertical integration nor horizontal mergers have brought down costs or led to higher-quality care.
Center for American Progress: How State Health Care Cost Commissions Can Advance Affordability and Equity (10/27) – Studies have shown that consolidation leads to higher health care prices, with hospital consolidation triggering 11 percent to 54 percent higher private insurance prices and 10 percent to 20 percent higher total expenditures per patient. Cost commissions can have the regulatory authority to confront hospital and provider consolidation. While some cost commissions simply set standards and goals, other states can monitor hospital and provider consolidation, administratively review mergers, and limit anti-competitive practices to preserve and promote market competition. Cost commissions can also protect consumers from the harms of health care industry consolidation via market oversight.
Pro Publica: How Effective Is the Government’s Campaign Against Hospital Mergers? (10/27) – What can be gleaned about hospital consolidation 15 months after Biden’s executive order? An examination of the cases the FTC has taken on — and those it hasn’t — suggests that so far the rhetoric has been more muscular than the reality. The agency initiated three challenges of hospital mergers during this period and allowed 54 to proceed without taking public action. One reason the numbers haven’t risen further is an impediment that is rarely mentioned outside of antitrust circles: The FTC’s guidelines focus exclusively on challenging mergers of hospitals within a single geographic region, not when a major player in one region buys up a hospital in a different one. And those so-called cross-market deals make up an increasing portion of hospital mergers. Not only does the FTC face that obstacle, it’s short on the money and staffing it would take to duke it out over big-time cross-market mergers.
JAMA:
Reexamining Social Determinants of Health Data Collection in the COVID-19 Era (10/27) – Data timeliness, a consumer-driven phenomenon, was ascendant even prior to the pandemic. Customers, or patients, have grown accustomed to the convenience of real-time access to people and information. Further, efforts at value-based care require data to be translated into actionable insights far sooner than in the encounter-based FFS business model. Indeed, by replacing FFS with episode-based payments, historic value-based payment models inherently incentivize health systems to address the negative externalities brought on by social determinants of health (ie, worse clinical outcomes and increased preventable health care utilization). New value-based models announced by the CMS Innovation Center are explicitly focusing on health equity as a priority, a necessary precondition to which is securing accurate data on population groups and social needs.
Bipartisan Policy Center: Improving and Strengthening Employer-Sponsored Insurance (10/27) – Policymakers and other stakeholders should address problems in the private health care market. Negotiations between providers and payers shape market prices. Prices are also shaped by geography, the demand for services, the market power of providers and payers, and other factors. Employers often do not possess enough market power to negotiate lower prices due to the consolidation of health care providers. Provider consolidation continues to accelerate, with nearly 67 percent of hospital markets now considered highly or very highly concentrated. Consolidation often drives health care price increases, according to a large body of evidence. BPC has proposed policies to equalize market power dynamics to foster a more competitive employer-sponsored health insurance system.
Center for American Progress: How To Improve Value in Medicare (10/26) – This report examines previous reforms to tie Medicare payment more closely to value, including the MSSP and models implemented through the CMS Innovation Center. It then recommends several policies aimed at reshaping the health care delivery system and leveraging competition in Medicare, including: sharpen the focus of Innovation Center demonstrations and make participation mandatory in models; expand competitive bidding for medical equipment and other supplies; halt the rise of coding intensity in Medicare Advantage; and introduce competitive bidding for Medicare Advantage plans.
|
