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Medicare, Medicaid, Health Reform

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Monthly Archives: January 2015

Big Data and Health Analytics: Using Data to Improve Health Care Decisions (Book Review)

While mountains of raw health care data continue to grow, the challenge of turning that data into usable, actionable information is largely being unmet. There are certainly tremendous new opportunities to use information to improve health care decisions at the purchaser, plan, provider, and patient levels and thereby improve outcomes and lower costs. However, the world of big data...

Integrating Physical and Behavioral Health Care in Medicaid

Delivery of physical medical care and behavioral health services is too often uncoordinated, operating in silos with little or no communication between physicians and other providers providing a patient with primary, specialty, acute, and pharmacy services and behavioral health professionals proving that same patient with mental health care or substance abuse treatment.  Naturally, the presence of a serious mental health...

Hospital Readmissions: Conditions, Cost, and Utilization Differences in Medicare, Medicaid, and Private Insurance

Hospital readmissions are costly but largely preventable. Reducing inpatient readmissions are a top priority for Medicare, state Medicaid programs, and private health plans.  The opportunities to lower costs and improve patient outcomes are considerable.  Therefore, healthcare purchasers are realigning hospital payment methods to reward hospitals for fewer readmissions and penalizing hospitals when a high number of patients return within 30...

Broken Hearts: The Tangled History of Cardiac Care by David S. Jones, MD, PhD (Review)

The basis for medical treatment of heart disease is the belief that interventions like coronary angioplasty and bypass surgery are effective, and that their benefits outweigh the risks. Does this conviction stem from a solid scientific foundation, or might it be an illusion? Is it conceivable that both physicians and patients are overestimating the advantages and underestimating the dangers? If...

Medicaid Managed Long Term Services and Supports (MLTSS): Issues and Guiding Principles

Managed Long Term Services and Supports (MLTSS) programs provide long-term care primarily to aging adults and people with disabilities. This care is provided not via the fee-for-service model but through managed care organizations. These contractors deliver benefits, which include community, home, and institution-based services, and receive payment through Medicaid. Unlike the fee-for-service system many states are moving away from...

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