Reimbursement
In order to survive in the ever-changing healthcare marketplace while saddled with new healthcare reform mandates, hospitals around the country must optimize three fundamental components of care delivery: clinical/operational integration, financial integration, and shared infrastructure and governance.
The Healthcare Group Purchasing Industry Initiative has released its seventh annual "Report to the Public," which finds that group purchasing organizations (GPOs) put the promotion of innovation and technology among their top priorities.
Robert Master, MD, has been trying to create a primary care model for poor, elderly and disabled patients in greater Boston since the late 1970s, and in 2003 he co-founded the not-for-profit Commonwealth Care Alliance, a delivery system for Medicaid-Medicare dual eligible, developmentally and physically disabled patients.
The Centers for Medicare & Medicaid Services (CMS) has proposed several dozen regulatory updates to Medicare Advantage and Part D prescription drug plans, covering cost sharing, minimum loss ratios, risk adjustment, payment methodologies and other policies.
Medicare patients can anticipate paying considerably less for their diabetes and other products starting in July when the Centers for Medicare & Medicaid Services expands its competitive bidding for durable medical equipment (DME) and mail-order program but the DME industry continues to point out problems with the program.
A report released last month by the California HealthCare Foundation found that total and operating margins in the state's hospitals were higher than they have been in the past nine years -- 5.1 percent and 3.1 percent respectively. But looking beyond those two basic numbers, hospitals are working on razor-thin margins.
A new study is adding fuel to the debate over the value of copay offset cards, used to defer a patient's copayment for prescription medications.
After President Obama suggested reducing "taxpayer subsidies to prescription drug companies" as an avenue for Medicare savings in his State of the Union speech, the Pharmaceutical Research and Manufacturers of America trade group went on the offensive, saying it would "upend the successful Medicare Part D prescription drug program by imposing government price controls on it" and "harm Part D's competitive dynamics, yielding higher premiums."
At President Obama's State of the Union address, Oregon Governor John Kitzhaber, a guest of Michelle Obama, might have been hoping for a mention of Oregon's ambitious Medicaid reform program, an ACO-like financing and delivery redesign that may eventually extend to Medicare members, public-sector employees and even privately-insured residents.
As a result of the Affordable Care Act and the additional 30 million new customers who will be shopping for and buying insurance products starting in October, health insurance companies are trying to find ways to change their business model. Whereas insurers' focus for decade has been on B-to-B relationships, this new world of healthcare consumerism will make it necessary to become focused on a retail consumer market.