Kip Piper's Health Care Blog
Medicare, Medicaid, Health Reform

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Monthly Archives: August 2013

Medicare Spending: Causes of Slower Growth in Medicare Fee for Service

Various economists and health care policy experts have tried to explain the recent slowdown in health spending growth. Some say it’s because of the Affordable Care Act, whose major provisions have yet to take effect. Others say it’s because of the economic slowdown, suggesting that the decrease in spending growth is demand driven and only temporary. Now, a new...

Risk Adjustment for Health Plans Under ACA: Evaluating, Improving Risk Adjustment Models

Risk adjustment is a key mechanism to ensuring appropriate payments for Medicare Advantage plans, Medicare Part D drug plans, and Medicaid health plans.  Since health plans vary in their mix of healthy and sick enrollees, risk adjustment modifies premium payments to better reflect the projected costs of members served and compensate plans that enroll high-cost patients. Historically, risk adjustment was only...

Medicare Spending, Beneficiaries, Providers, Health Plans, and Drug Plans: MedPAC Data Book for 2013

Medicare will spend $598.4 billion on health care services for seniors and the disabled in 2013 and about $635 billion in 2014.  Medicare expenditures will top $1 trillion in 2021, according to CMS actuarial projections. Medicare spending patterns and payment policies are highly complex and change constantly. The Affordable Care Act (ACA) makes further, very significant changes to how Medicare...

Multi-Payor Medical Homes: Actions to Limit Anti-Trust Liability

Multi-payor medical home initiatives have many benefits. They can bring Medicare, Medicaid, and private health plans together to promote care coordination, better health outcomes, and lower costs. But they have one potential flaw: Allowing payors to coordinate payment policies could trip federal (or state) anti-trust protections to prevent price-fixing and anti-competitive behavior in a marketplace. A recent Commonwealth Fund brief...

Individual Health Insurance Market under ACA: Lessons from Medicare Part D

The individual health insurance market undergoes dramatic changes in 2014 under the Affordable Care Act, especially for health plans offering coverage through the new Health Insurance Exchanges.  The ACA’s regulatory and financial framework present challenges for health insurers in selling coverage, managing risk, ensuring compliance, and adapting to future changes. To reduce risk and plan for the post-ACA marketplace, health...

Hospital Costs: Handful of Conditions Account for Half of Hospital Costs

Hospital costs are of keen interest to Medicare, Medicaid, and private health insurers these days, who pay the vast majority of hospital costs. Which services are the most expensive? Which types of health coverage are responsible for most of the costs? A new statistical brief from the Health Costs and Utilization Project (HCUP) has some interesting data to answer...

Smoking Cessation Coverage for Pregnant Women in Medicaid and Health Insurance Exchanges

The Affordable Care Act (ACA) coverage expansions to childless adults, through Medicaid and Health Insurance Exchanges, could have broad effects on public health. A recent study gives us one good example of that by showing that pregnant women in Medicaid with tobacco cessation coverage were less likely to smoke during pregnancy, but only if they had such coverage before...

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