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Monthly Archives: August 2012

Health Reform Implementation in States: Progress in Minnesota, New Mexico, and Virginia

The Robert Wood Johnson Foundation and the Urban Institute continue their series of reports on how states are implementing policies of the Affordable Care Act (ACA). The latest reports look at Minnesota, New Mexico, and Virginia. The sections below include a few points of comparison from the briefs about how each state is doing in key areas. Overall, the reports...

Medicare Value-Based Physician Payment Modifier: Recommendations from Physicians, Health Plans, and Policy Experts

Medicare is slowly but steadily moving toward value-based methods of reimbursing physicians, hospitals, and other health care providers differentially based on quality and cost of care.  The evolving payment methods add performance or value-based modifiers to traditional Medicare fee-for-service reimbursement.  For physicians, new value-based payment modifiers will adjust each provider's payment rates under the Medicare Part B fee schedule according to their performance compared to measures of quality and...

Interactive Preventive Health Records: Handbook for Primary Care Physicians on Tool to Increase Preventive Care

A new, highly personalized online resource for patients increases the delivery of recommended preventive services.  The Agency for Healthcare Research and Quality (AHRQ) has published a handbook for primary care physicians interested in launching a web-based portal where patients can review their records and manage preventive care. The portal, called an Interactive Preventive Health Record (IPHR), is an online web-based tool that...

Medicaid Payment Reform: State Medicaid Directors Contemplate Sustainable Reforms

Medicaid directors have been pushed to find cost savings in their programs in the midst of recent budget shortfalls, often using blunt instruments such as cuts in benefits, provider rates, and eligibility. But Medicaid directors are also evaluating and implementing more sustainable reforms to ensure Medicaid continues to provide quality services within tight state budgets, a report from the...

Medicare Advantage Market in 2012: Enrollment, Plans, and Premiums

Medicare Advantage plans now serve over 27 percent of all Medicare beneficiaries, according to the Kaiser Family Foundation's annual update on the Medicare Part C program. In 2012, Medicare Advantage plans serve 13.1 million beneficiaries, a jump of over one million - 10 percent - compared to last year. Medicare Advantage Plan Enrollment in 2012: Here are some highlights on Medicare Advantage plan enrollment in...

Medicare Advantage Special Needs Plans: SNP Enrollment Grows to 1.4 Million in 2012

Special Needs Plans are a type of Medicare Advantage plan that is allowed to selectively market and enroll Medicare beneficiaries with special needs.  Special Needs Plans (SNPs) offer the opportunity to improve care for Medicare beneficiaries with special needs, primarily through improved coordination and continuity of care.  SNPs must also meet additional standards for care delivery and quality of care. Today,...

Medicaid Patients in Emergency Rooms: Most Medicaid Visits for Emergencies or Urgent Needs, Not Routine Care

The notion that Medicaid patients rely heavily on hospital emergency departments for routine care is false, argues a recent recent study by the Center for Studying Health System Change, which looked at a series of common misapprehensions about emergency department use. Only 10 percent of emergency department visits by nonelderly Medicaid patients were for non-urgent symptoms, compared to seven percent...

Shared Decision Making by Physicians and Patients: Actions for Employers to Improve Health and Reduce Costs

Employers should encourage shared decision-making - which involves patients in health care decisions - as a way to reduce medical costs and improve health outcomes among employees, argues a recent brief from the National Business Coalition on Health (NBCH). Patients who have a better understanding of and are more involved in health care decisions are less likely to use...

Wellness Incentive Programs: Lessons from Germany for Wellness Program Expansion under the ACA

Based on data from Germany’s experience with wellness programs, a recent report cautions that wellness incentives under the Affordable Care Act (ACA) could lead to higher insurance premiums for low-income and chronically ill people. The Commonwealth Fund’s brief found that one quarter of the publicly insured population participated in wellness programs by 2008, double the participation in 2004. Wellness...

Medicare Part D and Dual Eligibles: Prescription Drug Formularies and Drugs Used by Dual Eligibles

Medicare Part D prescription drug plan formularies in 2012 covered 96 percent of the drugs most used by people eligible for both full Medicare benefits and Medicaid - full benefit dual eligibles - according to the Department of Health and Human Services Office of Inspector General (OIG). That figure is essentially unchanged from 2011, the OIG’s report says. The Affordable Care...

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